{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,30]],"date-time":"2025-10-30T11:35:08Z","timestamp":1761824108516,"version":"build-2065373602"},"reference-count":12,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["Reg Anesth Pain Med"],"accepted":{"date-parts":[[2018,12,19]]},"published-print":{"date-parts":[[2019,4]]},"abstract":"<jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Determining safer techniques for lumbar injections is an important goal in pain medicine. This study aims to characterize the location of the T10\u2013L5 spinal arteries using CT angiogram scans to define a safer approach for sympathetic and splanchnic blocks that minimizes intra-arterial injection.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>CT angiograms of 68 patients were included this study. The path of the spinal arteries from the aorta origin along the vertebral body to the neural foramina was traced on axial CT images. The sagittal plane of the vertebral body was divided into nine quadrants to map the path of a spinal artery at a vertebral level. At a given vertebral level and laterality, the presence of an artery as well as the quadrants the artery traveled in along its path were recorded.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>At the anterior vertebral body, &gt;90% of the spinal arteries were observed either at or below the pedicle level. At the middle portion of the vertebral body from T11 to L3, &gt;80% of the spinal arteries were found at the pedicle level. For the posterior portion of the vertebral bodies at L4 and L5, the spinal arteries terminated almost universally below the pedicle level. For other levels at the posterior vertebral bodies, the spinal arteries were equivocally located at or below the pedicle level.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Using routine anatomic landmarks visible on CT imaging, we classified the anatomic course of low thoracic and lumbar spinal arteries originating from the aorta into the neural foraminal space. A safe recommendation to avoid intra-arterial injection for a splanchnic or lumbar sympathetic is to start above the pedicle and add a slight caudal angulation to the needle trajectory to avoid disc injury at the anterolateral vertebral body.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rapm-2018-100097","type":"journal-article","created":{"date-parts":[[2019,2,15]],"date-time":"2019-02-15T16:31:53Z","timestamp":1550248313000},"page":"507-512","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":2,"title":["CT angiography depicted lumbar spinal artery anatomic course: defining a safer zone for lumbar sympathetic and splanchnic blocks"],"prefix":"10.1136","volume":"44","author":[{"given":"Richard","family":"Zhu","sequence":"first","affiliation":[{"name":"Interventional Pain Management, Greenwich Hospital, Greenwich, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathryn","family":"Dean","sequence":"additional","affiliation":[{"name":"Radiology, Cornell University Joan and Sanford I Weill Medical College, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2761-7903","authenticated-orcid":false,"given":"Neel","family":"Mehta","sequence":"additional","affiliation":[{"name":"Anesthesiology, Cornell University Joan and Sanford I Weill Medical College, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajay","family":"Gupta","sequence":"additional","affiliation":[{"name":"Radiology, Cornell University Joan and Sanford I Weill Medical College, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jesse","family":"Gruber","sequence":"additional","affiliation":[{"name":"Anesthesiology, NewYork-Presbyterian Hospital, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amitabh","family":"Gulati","sequence":"additional","affiliation":[{"name":"Anesthesiology, Memorial Sloan Kettering Cancer Center, New York City, New York, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,2,15]]},"reference":[{"key":"2025101109135688000_44.4.507.1","doi-asserted-by":"crossref","first-page":"37","DOI":"10.1097\/00003086-198606000-00008","article-title":"Posterolateral percutaneous suction-excision of herniated lumbar intervertebral discs. Report of interim results","volume":"207","author":"Kambin","year":"1986","journal-title":"Clin Orthop Relat Res"},{"key":"2025101109135688000_44.4.507.2","doi-asserted-by":"publisher","DOI":"10.5535\/arm.2011.35.6.833"},{"key":"2025101109135688000_44.4.507.3","doi-asserted-by":"crossref","first-page":"498","DOI":"10.1016\/j.wneu.2017.01.057","article-title":"Anatomic assessment of variations in Kambin's triangle: a surgical and cadaver study","volume":"100","author":"Ozer","year":"2017","journal-title":"World Neurosurg"},{"key":"2025101109135688000_44.4.507.4","doi-asserted-by":"crossref","unstructured":"Stone JB , Gilhool JJ , Furman MB . Atlas of image-guided spinal procedures. Philadelphia: Elsevier, 2018: 291\u20136.","DOI":"10.1016\/B978-0-323-40153-1.00032-9"},{"key":"2025101109135688000_44.4.507.5","unstructured":"Rathmell JP . Lumbar Sympathetic Block and Neurolysis. In: Rathmell JP , ed. Atlas of image-guided intervention in regional anesthesia and Pain medicine. Philadelphia: Lippincott Williams & Wilkins, 2012: 176\u201386."},{"key":"2025101109135688000_44.4.507.6","doi-asserted-by":"crossref","unstructured":"Datta S , Pai UT , Manchikanti L . Lumbar Sympathetic Block. In: Manchikanti L , Kaye AD , Falco FJE , et al , eds. Essentials of interventional techniques in managing chronic pain. New York: Springer International Publishing, 2018: 551\u201371.","DOI":"10.1007\/978-3-319-60361-2_35"},{"key":"2025101109135688000_44.4.507.7","unstructured":"Prager JP . Lumbar Sympathetic Block. In: Diwan S , Staats P , eds. Atlas of pain medicine procedures. New York: McGraw-Hill Publishers, 2015: 800\u201313."},{"key":"2025101109135688000_44.4.507.8","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1177\/028418517601700301","article-title":"Spinal cord vascularity. III. the spinal cord arteries in man","volume":"17","author":"Tveten","year":"1976","journal-title":"Acta Radiol Diagn"},{"key":"2025101109135688000_44.4.507.9","doi-asserted-by":"crossref","first-page":"1194","DOI":"10.1097\/BRS.0000000000000909","article-title":"The impact of preoperative angiographic identification of the artery of Adamkiewicz on surgical decision making in patients undergoing thoracolumbar Corpectomy","volume":"40","author":"Fanous","year":"2015","journal-title":"Spine"},{"key":"2025101109135688000_44.4.507.10","first-page":"46","article-title":"Location of radicular spinal arteries in the lumbar spine from analysis of CT angiograms of the abdomen and pelvis","volume":"17","author":"Simon","year":"2016","journal-title":"Pain Med"},{"key":"2025101109135688000_44.4.507.11","doi-asserted-by":"crossref","first-page":"217","DOI":"10.36076\/ppj.2004\/7\/217","article-title":"Evaluation of lumbar transforaminal epidural injections with needle placement and contrast flow patterns: a prospective, descriptive report","volume":"7","author":"Manchikanti","year":"2004","journal-title":"Pain Physician"},{"key":"2025101109135688000_44.4.507.12","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2010.00948.x"}],"container-title":["Regional Anesthesia &amp; Pain Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/rapm-2018-100097","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T16:14:03Z","timestamp":1760199243000},"score":1,"resource":{"primary":{"URL":"https:\/\/rapm.bmj.com\/lookup\/doi\/10.1136\/rapm-2018-100097"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,2,15]]},"references-count":12,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2019,3,26]]},"published-print":{"date-parts":[[2019,4]]}},"alternative-id":["10.1136\/rapm-2018-100097"],"URL":"https:\/\/doi.org\/10.1136\/rapm-2018-100097","relation":{},"ISSN":["1098-7339","1532-8651"],"issn-type":[{"type":"print","value":"1098-7339"},{"type":"electronic","value":"1532-8651"}],"subject":[],"published":{"date-parts":[[2019,2,15]]}}}