Artery of Adamkiewicz: a meta-analysis of anatomical characteristics

Abstract

Purpose The artery of Adamkiewicz (AKA) provides the major blood supply to the anterior thoracolumbar spinal cord and iatrogenic injury or inadequate reconstruction of this vessel during vascular and endovascular surgery can result in postoperative neurological deficit due to spinal cord ischemia. The aim of this study was to provide comprehensive data on the prevalence and anatomical characteristics of the AKA. Methods An extensive search was conducted through the major electronic databases to identify eligible articles. Data extracted included study type, prevalence of the AKA, gender, number of AKA per patient, laterality, origin based on vertebral level, side of origin, morphometric data, and ethnicity subgroups. Results A total of 60 studies ( n = 5437 subjects) were included in the meta-analysis. Our main findings revealed that the AKA was present in 84.6% of the population, and patients most frequently had a single AKA (87.4%) on the left side (76.6%) originating between T8 and L1 (89%). Conclusion As an AKA is present in the majority of the population, caution should be taken during vascular and endovascular surgical procedures to avoid injury or ensure proper reconstruction. All surgeons operating in the thoracolumbar spinal cord should have a thorough understanding of the anatomical characteristics and surgical implications of an AKA. Electronic supplementary material The online version of this article (10.1007/s00234-019-02207-y) contains supplementary material, which is available to authorized users.

Anterior Spinal Cord Syndrome is a Complication Following Embolisation of Bleeding Intercostal Artery in Penetrating Trauma: A Case Report

“…As it courses down the anterior median ssure, it is reinforced by several radicular arteries -the largest being the great anterior radiculomedullary artery. Also known as the artery of Adamkiewicz (AKA), it plays a signi cant role in the arterial supply of the anterior spinal cord from the level of T8 to the conus medullaris (4). Its origin is highly variable -with the majority (~70%) arising from the T8 to L1 neural foramina from the intercostal or lumbar arteries on the left side (4,5).…”

“…Also known as the artery of Adamkiewicz (AKA), it plays a signi cant role in the arterial supply of the anterior spinal cord from the level of T8 to the conus medullaris (4). Its origin is highly variable -with the majority (~70%) arising from the T8 to L1 neural foramina from the intercostal or lumbar arteries on the left side (4,5). The AKA makes a characteristic "hairpin" turn as it joins the anterior spinal artery.…”

“…Occlusion of the AKA typically presents with anterior spinal artery syndrome where there is symmetrical motor dysfunction and spinothalamic sensory de cit below the level of the lesion, as well as autonomic sphincter dysfunction. Identi cation of the AKA helps reduce the risk of ischaemic spinal complications in vascular and endovascular procedures (4). In a study by Yoshioka et al (6), 30 patients with thoracoabdominal or descending thoracic aortic aneurysms underwent pre-operative gadolinium-enhanced MR angiography and CT angiography to visualise the AKA.…”

Magnetic resonance imaging anatomy and morphometry of lumbar intervertebral foramina to guide safe transforaminal subarachnoid punctures

“…Moreover, L1–L2 IVFs demonstrated the opposite association, since crescents at these levels contained neurovascular structures more frequently than at other levels. It is known that the artery of Adamkiewicz, the major arterial supply of the anterior thoracolumbar spine, most often enters the spine through an IVF between the T8–T9 and L1–L2 levels on its path to anastomose with the anterior spinal artery (Murthy et al, ; Taterra et al, ). Additionally, the great anterior medullary vein, the venous equivalent of the artery of Adamkiewicz, arises in the lower thoracic and upper lumbar spine and travels with the nerve roots from T11 to L3.…”

Spatially resolved optical monitoring of spinal cord blood flow with a minimally invasive, multi-level epidural probe

“…To date, efforts to image the critical spinal cord blood supply preoperatively to guide surgical intervention have met with mixed success. [11][12][13][14][15][16][17] The vasculature supplying the spinal cord is complex 18 and exhibits large inter-subject variability 19,20 in both native vascular anatomy and as a result of prior aortic disease. These factors help to explain the frustration of efforts to prevent spinal cord ischemia.…”