May 30, 2024

Artery of Adamkiewicz Aka Arteria radicularis magna

This is the principle vessel that feeds the lower thoracic, lumbar, and sacral portion of the spinal cord

It is derived from a single posterior intercostal artery originating from the aorta between the levels of T9-L5

Artery of Adamkiewicz
Artery of Adamkiewicz

Vascular Anatomy of Spinal Cord

Extrinsic Vasculature

  • Segmental vessels arising from lumber and posterior intercostals arteries
  • Subclavian arteries
  • Hypogastric arteries
  • Vasculature of para spinous muscles

Intrinsic Vasculature

  • Dual blood supply feeding anterior and posterior region of spinal cord
  • Anterior and Posterior Spinal artery

Anterior Spinal Artery (ASA):  Provides perfusion to the majority of the anterior portion of the spinal cord

ASA arises from the terminal ends of vertebral arteries and courses on the midline surface in the medial longitudinal fissure of the spinal cord while supplied by several extrinsic contributory arteries.

AKA supplies caudal 2/3rd of ASA

Around 68% of perfusion to lower thorax and upper lumbar areas is provided by AKA

It is the only major blood supply to this zone which is particularly susceptible to ischemia: WATERSHED AREA

Unique shape: Hairpin curve/loop/turn

Branches of thoracic artery
Branches of thoracic artery

Lesion to the artery of Adamkiewicz

Injury to it occurs due to

  • Aortic dissection
  • Fibrocalcified emboli
  • Gas emboli
  • Aneurysm
  • Atheroma
  • Trauma

This results in decreased perfusion of the thoracoabdominal region of ASA because of a lack of collateral blood flow and poor anastomosis to this region

This may lead to Anterior Cord Syndrome