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Artery of Adamkiewicz

The Artery of Adamkiewicz, also known as the great anterior radiculomedullary artery, is the largest and most significant segmental medullary artery supplying the spinal cord. It plays a critical role in providing blood flow to the lower two-thirds of the spinal cord, particularly the lumbar and sacral regions.

Anatomy and Origin

  • Origin: Typically arises from a posterior branch of an intercostal artery (usually between T9 and T12 levels) or from a lumbar artery.
  • Side Predominance: In about 75% of individuals, it originates on the left side.
  • Course: After its origin, it enters the vertebral canal through an intervertebral foramen and ascends to join the anterior spinal artery.
  • Variation: The exact level of origin can vary significantly, ranging from T5 to L2.

Physiological Significance

  • Blood Supply: Supplies the anterior two-thirds of the spinal cord, including the anterior horn cells and corticospinal tracts.
  • Function: Essential for motor function, as it nourishes motor neurons responsible for movement.

Clinical Relevance

  • Spinal Cord Ischemia: Damage or occlusion can lead to anterior spinal artery syndrome, resulting in paralysis and loss of pain and temperature sensation below the lesion.
  • Surgical Considerations: Critical during surgeries involving the aorta (e.g., aneurysm repair) to prevent inadvertent injury that could cause paraplegia.
  • Imaging: Preoperative identification via spinal angiography or magnetic resonance angiography (MRA) is recommended.

Pathophysiology

  • Vulnerability: Due to its significant contribution to spinal cord perfusion, it's susceptible to ischemia during systemic hypotension or aortic pathology.
  • Anterior Spinal Artery Syndrome: Characterized by motor paralysis and dissociated sensory loss (pain and temperature), with preserved dorsal column functions (proprioception and vibration).

Diagnostic and Imaging Techniques

  • Magnetic Resonance Angiography (MRA): Non-invasive method to visualize the artery's course and origin.
  • Computed Tomography Angiography (CTA): Provides high-resolution images but involves radiation exposure.
  • Digital Subtraction Angiography (DSA): Gold standard for detailed vascular mapping but is invasive.

Surgical Implications

  • Aortic Aneurysm Repair: Identification and preservation are crucial to prevent postoperative neurological deficits.
  • Spinal Cord Protection Strategies: Techniques like hypothermia, cerebrospinal fluid drainage, and maintaining adequate perfusion pressure are employed.

Recent Advances

  • Endovascular Techniques: Minimally invasive approaches reduce the risk of disrupting the artery.
  • Neuromonitoring: Intraoperative monitoring of spinal cord function helps detect ischemia early.