Anatomical study of the thoracolumbar radiculomedullary arteries, including the Adamkiewicz artery and supporting radiculomedullary arteries

Jorge E. AlverniaDepartment of Neurosurgery, University of Mississippi, Jackson, Mississippi;
Brain and Spine Associates, Monroe, Louisiana;

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Emile SimonDepartment of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France;
Laboratory of Anatomy, Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France;

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Krishnakant KhandelwalDepartment of Neurosurgery, University of Mississippi, Jackson, Mississippi;

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Cara D. RamosDepartment of Neurosurgery, University of Mississippi, Jackson, Mississippi;

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Eddie PerkinsDepartment of Neurosurgery, University of Mississippi, Jackson, Mississippi;

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Patrick KimDepartment of Neurosurgery, University of Mississippi, Jackson, Mississippi;

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Patrick MertensDepartment of Neurosurgery, Hospices Civils de Lyon, Hôpital Neurologique Pierre Wertheimer, Bron, France;
Laboratory of Anatomy, Faculty of Medicine Lyon Est, Claude Bernard University Lyon 1, Lyon, France;

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Raffaella MessinaDivision of Neurosurgery University "Aldo Moro" of Bari, Italy; and

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Gustavo LuzardoDepartment of Neurosurgery, University of Mississippi, Jackson, Mississippi;

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Orlando DiazDepartment of Neurosurgery, Houston Methodist Hospital, Houston, Texas

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Publication Date:
23 Sep 2022
Page Range:
233–241
Volume/Issue:
Volume 38: Issue 2
DOI link:
https://doi.org/10.3171/2022.5.SPINE2214
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OBJECTIVE

The aim of this paper was to identify and characterize all the segmental radiculomedullary arteries (RMAs) that supply the thoracic and lumbar spinal cord.

METHODS

All RMAs from T4 to L5 were studied systematically in 25 cadaveric specimens. The RMA with the greatest diameter in each specimen was termed the artery of Adamkiewicz (AKA). Other supporting RMAs were also identified and characterized.

RESULTS

A total of 27 AKAs were found in 25 specimens. Twenty-two AKAs (81%) originated from a left thoracic or a left lumbar radicular branch, and 5 (19%) arose from the right. Two specimens (8%) had two AKAs each: one specimen with two AKAs on the left side and the other specimen with one AKA on each side. Eight cadaveric specimens (32%) had 10 additional RMAs; among those, a single additional RMA was found in 6 specimens (75%), and 2 additional RMAs were found in each of the remaining 2 specimens (25%). Of those specimens with a single additional RMA, the supporting RMA was ipsilateral to the AKA in 5 specimens (83%) and contralateral in only 1 specimen (17%). The specimens containing 2 additional RMAs were all (100%) ipsilateral to their respective AKAs.

CONCLUSIONS

The segmental RMAs supplying the thoracic and lumbar spinal cord can be unilateral, bilateral, or multiple. Multiple AKAs or additional RMAs supplying a single anterior spinal artery are common and should be considered when dealing with the spinal cord at the thoracolumbar level.

ABBREVIATIONS

AKA = artery of Adamkiewicz; ASA = anterior spinal artery; PSA = posterior spinal artery; RMA = radiculomedullary artery; SDAVF = spinal dural arteriovenous malformation.
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Cover Journal of Neurosurgery: Spine

Volume 38: Issue 2 (Feb 2023)

in Journal of Neurosurgery: Spine
Illustration from Alvernia et al. (pp 233–241). © Jorge Alvernia, published with permission.

Contributor Notes

Correspondence Jorge E. Alvernia: University of Mississippi Medical Center, Jackson, MS. jalvernia@yahoo.com.

INCLUDE WHEN CITING Published online September 23, 2022; DOI: 10.3171/2022.5.SPINE2214.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

ACCOMPANYING EDITORIAL DOI: 10.3171/2022.6.SPINE22532.

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