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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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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  • 1

    Djindjian R. Angiography of the Spinal Cord. University Park Press;1970.

  • 2

    Hoehmann C, Hitscherich K, Cuoco J. The artery of Adamkiewicz: vascular anatomy, clinical significance and surgical considerations. Int J Cardiovasc Res. 2016;5(6).

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 3

    Lazorthes G, Gouaze A, Zadeh JO, Santini JJ, Lazorthes Y, Burdin P. Arterial vascularization of the spinal cord. Recent studies of the anastomotic substitution pathways. J Neurosurg. 1971;35(3):253262.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 4

    Soubeyrand M, Court C, Fadel E, et al. Preoperative imaging study of the spinal cord vascularization: interest and limits in spine resection for primary tumors. Eur J Radiol. 2011;77(1):2633.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 5

    Guziński M, Bryl M, Ziemińska K, Wolny K, Sąsiadek M, Garcarek JS. Detection of the Adamkiewicz artery in computed tomography of the thorax and abdomen. Adv Clin Exp Med. 2017;26(1):3137.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 6

    Backes WH, Nijenhuis RJ. Advances in spinal cord MR angiography. AJNR Am J Neuroradiol. 2008;29(4):619631.

  • 7

    Bley TA, Duffek CC, François CJ, et al. Presurgical localization of the artery of Adamkiewicz with time-resolved 3.0-T MR angiography. Radiology. 2010;255(3):873881.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 8

    Kawaharada N, Morishita K, Hyodoh H, et al. Magnetic resonance angiographic localization of the artery of Adamkiewicz for spinal cord blood supply. Ann Thorac Surg. 2004;78(3):846852.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 9

    Amato ACM, Stolf NAG. Anatomia da circulação medular. J Vasc Bras. 2015;14(3):248252.

  • 10

    Murthy NS, Maus TP, Behrns CL. Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz): a retrospective review. Pain Med. 2010;11(12):17561764.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 11

    Martirosyan NL, Kalani MYS, Lemole GM Jr, Spetzler RF, Preul MC, Theodore N. Microsurgical anatomy of the arterial basket of the conus medullaris. J Neurosurg Spine. 2015;22(6):672676.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 12

    Kudo K, Terae S, Asano T, et al. Anterior spinal artery and artery of Adamkiewicz detected by using multi-detector row CT. AJNR Am J Neuroradiol. 2003;24(1):1317.

    • Search Google Scholar
    • Export Citation
  • 13

    Martirosyan NL, Feuerstein JS, Theodore N, Cavalcanti DD, Spetzler RF, Preul MC. Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions. J Neurosurg Spine. 2011;15(3):238251.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 14

    Melissano G, Bertoglio L, Civelli V, et al. Demonstration of the Adamkiewicz artery by multidetector computed tomography angiography analysed with the open-source software OsiriX. Eur J Vasc Endovasc Surg. 2009;37(4):395400.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 15

    Ou P, Schmit P, Layouss W, Sidi D, Bonnet D, Brunelle F. CT angiography of the artery of Adamkiewicz with 64-section technology: first experience in children. AJNR Am J Neuroradiol. 2007;28(2):216219.

    • Search Google Scholar
    • Export Citation
  • 16

    Ueda Y, Kawahara N, Tomita K, Kobayashi T, Murakami H, Nambu K. Influence on spinal cord blood flow and function by interruption of bilateral segmental arteries at up to three levels: experimental study in dogs. Spine (Phila Pa 1976). 2005;30(20):22392243.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 17

    Fujimaki Y, Kawahara N, Tomita K, Murakami H, Ueda Y. How many ligations of bilateral segmental arteries cause ischemic spinal cord dysfunction? An experimental study using a dog model. Spine (Phila Pa 1976). 2006;31(21):E781E789.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 18

    Kato S, Kawahara N, Tomita K, Murakami H, Demura S, Fujimaki Y. Effects on spinal cord blood flow and neurologic function secondary to interruption of bilateral segmental arteries which supply the artery of Adamkiewicz: an experimental study using a dog model. Spine (Phila Pa 1976). 2008;33(14):15331541.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 19

    Tan T, Rutges J, Marion T, Fisher C, Tee J. The safety profile of intentional or iatrogenic sacrifice of the artery of Adamkiewciz and its vicinity’s spinal segmental arteries: a systematic review. Global Spine J. 2020;10(4):464475.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 20

    Murakami H, Kawahara N, Tomita K, Demura S, Kato S, Yoshioka K. Does interruption of the artery of Adamkiewicz during total en bloc spondylectomy affect neurologic function? Spine (Phila Pa 1976). 2010;35(22):E1187E1192.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 21

    Nijenhuis RJ, Mull M, Wilmink JT, Thron AK, Backes WH. MR angiography of the great anterior radiculomedullary artery (Adamkiewicz artery) validated by digital subtraction angiography. AJNR Am J Neuroradiol. 2006;27(7):15651572.

    • Search Google Scholar
    • Export Citation
  • 22

    Uotani K, Yamada N, Kono AK, et al. Preoperative visualization of the artery of Adamkiewicz by intra-arterial CT angiography. AJNR Am J Neuroradiol. 2008;29(2):314318.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 23

    Williams GM, Perler BA, Burdick JF, et al. Angiographic localization of spinal cord blood supply and its relationship to postoperative paraplegia. J Vasc Surg. 1991;13(1):2335.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 24

    Yoshioka K, Niinuma H, Ehara S, Nakajima T, Nakamura M, Kawazoe K. MR angiography and CT angiography of the artery of Adamkiewicz: state of the art. Radiographics. 2006;26(suppl 1):S63S73.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 25

    Arici T, Kurçaloğlu M, Eyıgor C, Uyar M. Transforaminal epidural steroid injection and infraneural approach. Agri. 2019;31(2):104106.

    • Search Google Scholar
    • Export Citation
  • 26

    Bohinski RJ, Rhines LD. Principles and techniques of en bloc vertebrectomy for bone tumors of the thoracolumbar spine: an overview. Neurosurg Focus. 2003;15(5):E7.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 27

    Langdon J, Way A, Heaton S, Bernard J, Molloy S. The management of spinal metastases from renal cell carcinoma. Ann R Coll Surg Engl. 2009;91(8):649652.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 28

    Miyasaka K, Asano T, Ushikoshi S, Hida K, Koyanagi I. Vascular anatomy of the spinal cord and classification of spinal arteriovenous malformations. Interv Neuroradiol. 2000;6(suppl 1):195198.

    • Crossref
    • Search Google Scholar
    • Export Citation
  • 29

    Krings T, Geibprasert S. Spinal dural arteriovenous fistulas. AJNR Am J Neuroradiol. 2009;30(4):639648.

  • 30

    Gailloud P. The artery of von Haller: a constant anterior radiculomedullary artery at the upper thoracic level. Neurosurgery. 2013;73(6):10341043.

    • Crossref
    • Search Google Scholar
    • Export Citation

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