Pre-operative coil-embolisation of a large, myelon-compressing vertebral metastasis involving the artery of Adamkiewicz

Abstract

Background The artery of Adamkiewicz (AKA) or arteria radicularis anterior magna, is the name of the thoracolumbar segment of the dominant radiculomedullary artery, supplying the anterior lower spinal cord in addition to the anterior spinal artery. Results of a meta-analysis by Taterra et al. [1] showed its prevalence in 84.6% of people, a predominantly single appearance, most commonly originating from the left intercostal or lumbar arteries (87.4%) between the levels of T8-L1 (89%) [1], and a mean diameter of 1 mm [2, 3]. The artery most commonly arises from the spinal branch of the posterior ramus of the segmental artery (subcostal, posterior intercostal, or lumbar artery), which in turn arises from the descending aorta. The distal portion of the AKA, together with the anterior spinal artery, forms a characteristic “hairpin” turn [4]. Its location and anatomical variability cause its vulnerability to injury, especially during surgical but also interventional procedures. Anatomical knowledge paired with accurate localization of the AKA is therefore an integral part in planning orthopedic/neurosurgical spine, aortic vascular surgery repair procedures and endovascular selective arterial embolizations in this area. Case presentation In this case of a 73-year-old female patient with progression of a large, myelon-compressing vertebral metastasis of L1, protective, blood-flow-controlling occlusion of the proximal-most points of the artery of Adamkiewicz artery (AKA) and segmental spinal arteries was safely performed prior to surgical decompression and tumor debulking. Conclusions Current evidence indicates that knowledge of AKA location and the amount of collateralization may help estimate the risk of post-interventional spinal cord injury.