Identifying Anatomical Predictors of Median Arcuate Ligament Overlap to Guide Selective Use of Contrast-Enhanced Computed Tomography in Adult Spinal Deformity Surgery

Introduction: Acute celiac artery compression syndrome (ACACS) is a rare but potentially life-threatening complication following surgery for adult spinal deformity (ASD); it is caused by compression of the celiac artery (CA) by the median arcuate ligament (MAL). MAL overlap, the condition in which the MAL overlaps the base of the CA, has been identified as a potential risk factor for ACACS after ASD surgery. However, the routine use of contrast-enhanced computed tomography (CT) to assess this condition poses risks such as allergy and renal dysfunction. The aim of this study was to identify anatomical predictors of MAL overlap using non-contrast imaging markers.