Analysis of Risk Factors for Development of Superior Mesenteric Artery Syndrome in Surgical Treatment of Spine Deformities in Children

Abstract

Background. Superior mesenteric artery (SMA) syndrome is a serious, potentially fatal complication that can be reversed by spinal deformity surgery. The protocol describes no more than 400 cases, and the risk factors for this development are clearly not known. Aims — analysis of the results of CT angiography of the abdominal aorta in patients with severe scoliotic spinal deformity to identify risk factors for the development of superior mesenteric artery syndrome. Methods. At the Department of Spinal Pathology and Neurosurgery of the Federal State Budgetary Institution “National Medical Research Center for Pediatric Traumatology and Orthopedics named after G.I. Turner” of the Ministry of Health of Russia CT angiography of the abdominal aorta in 13 pediatric patients with severe scoliotic deformities of the spine was performed. The direction of the SMA branch from the aorta, the aortomesenteric angle and the distance between the anterior wall of the aorta and the posterior wall of the SMA at the level of the duodenum (DU) were determined. If the values of the last two parameters deviated from the norm, patients underwent videogastroduodenoscopy to assess the condition of the duodenum and the patency of its subbulb part. Results. In 4 patients branch a. mesenterica superior was left-sided, in 3 of these patients, when performing videogastroduodenoscopy, signs of compression of the extra-bulbular region from the outside were revealed — 1 patient developed SMA syndrome in the post-op period, which required drainage intervention on the intestine. When conducting a more thorough assessment of MSCT data, it was found that in the presence of severe deformity of the spinal column, infringement of the horizontal portion of the duodenum can occur between a. mesenterica superior and the ventral surface of the vertebral bodies. In a number of patients with a decrease in the aortomesenteric angle, compression of the duodenum was not observed due to its lower location and the increased distance between the anterior wall of the aorta and the posterior wall of the SMA at this level. Conclusions. Possible risk factors for the development of SMA syndrome include the left-sided direction of branch a. mesenterica superior from the aorta. In some cases, in patients with clinical signs of SMA syndrome, infringement of the horizontal portion of the duodenum may occur between a. mesenterica superior and the spinal column, and not the aorta. The traditional method of measuring the aortomesenteric distance is not always correct — in patients with spinal deformity and clinical signs of SMA syndrome, due to the presence of changes in the spatial position of the internal organs, this distance must be measured at the level of the horizontal portion of the duodenum.