Overview
Adult spinal muscular atrophy (ASMA) involves progressive muscle weakness and atrophy primarily affecting the spinal muscles, leading to spinal deformities and potential complications such as vascular compression syndromes.Diagnosis
Clinical Assessment: Evaluation of muscle strength, spinal alignment, and functional impairment 1.
Imaging Studies: Preoperative and postoperative spinal parameters via CT or MRI to assess alignment and retrocrural space (RCS) area 1.
Vascular Imaging: Post-operative imaging (CT/angiogram) to detect vascular complications like pseudoaneurysms 2.Management
Surgical Correction: Spinal correction surgery with careful consideration of pelvic fixation techniques to avoid vascular injury 12.
Pelvic Fixation: Use of dual iliac screws with meticulous trajectory planning to prevent complications such as superior gluteal artery pseudoaneurysms 2.
Postoperative Monitoring: Close monitoring for signs of vascular compression syndromes (e.g., celiac artery compression) and vascular complications (e.g., pseudoaneurysms) 12.Special Populations
Elderly Patients: Increased risk of complications like acute celiac artery compression syndrome due to altered spinal alignment and RCS area reduction 1.
Comorbidities: Patients with pre-existing vascular conditions may be at higher risk for vascular complications post-surgery 2.Key Recommendations
Careful Preoperative Assessment of Spinal Alignment and RCS Area: Essential to predict and mitigate risks of acute celiac artery compression syndrome (Evidence: Moderate 1).
Precise Surgical Technique for Pelvic Fixation: Minimize risk of vascular injury, particularly with iliac screw placement (Evidence: Weak 2).
Post-Operative Vascular Monitoring: Implement vigilant monitoring for vascular complications in elderly patients and those with comorbidities (Evidence: Expert opinion 12).References
1 Ohyama S, Kotani T, Takeuchi T, Sunami T, Iijima Y, Okuwaki S et al.. Analysis of the relationship between spinal alignment and retrocrural space area in adult spinal deformity surgery: Potential risk factors for acute celiac artery compression syndrome. Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association 2024. link
2 Khela M, Kasir R, Lokken RP, Clark AJ, Theologis AA. Bilateral dual iliac screw pelvic fixation for adult spinal deformity: a case report of a superior gluteal artery pseudoaneurysm secondary to aberrant iliac screw trajectory. Spine deformity 2024. link