Four paired lumbar arteries arise from the posterior aorta at each lumbar vertebral level (L1-L4), wrapping around the vertebral bodies to supply the posterior spinal muscles, vertebral bodies, and spinal canal contents via dorsal and spinal branches. The 5th lumbar arteries typically arise from the median sacral artery or iliolumbar artery.
Lumbar segmental arteries are ligated during anterior lumbar spine surgery and lateral interbody fusion (LLIF). Unintentional injury produces retroperitoneal haematoma. The segmental artery to L1 may contribute to the artery of Adamkiewicz, so preoperative identification with CTA is important in thoracolumbar spinal surgery.
Traumatic or iatrogenic lumbar segmental artery laceration producing a retroperitoneal haematoma, presenting with flank pain, dropping haematocrit, and psoas shadow obliteration on plain film.
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