Upper and lower spinal cord blood supply: the continuity of the anterior spinal artery and the relevance of the lumbar arteries.
OBJECTIVE
Thoracic and thoracoabdominal aortic repair are still complicated by spinal cord ischemia and paraplegia. The aim of the present article is to present the results of an anatomical study conducted by means of both postmortem injection of the vertebral artery and perfusion of the abdominal aorta.


METHODS
The spinal cord blood supply was investigated in 51 Caucasian cadavers: in 40 cases a methylene blue solution was hand-injected into the vertebral artery, whereas in the remaining 11 cases the abdominal aorta was perfused with a methylene blue solution by means of a roller pump. The level and side of the arteria radicularis magna and the continuity of the anterior spinal artery were recorded.


RESULTS
The anterior spinal artery was a continuous vessel without interruptions along the spinal cord in all 51 cases. The arteria radicularis magna level was variable, ranging from T9 to L5. The arteria radicularis magna arose from a lumbar artery in 36 cases (70.5%) and it was left-sided in 32 cases (62.7%).


CONCLUSIONS
The anterior spinal artery constitutes an uninterrupted pathway between the vertebral arteries, the arteria radicularis magna, and the posterior intercostal and lumbar arteries. Moreover, the arteria radicularis magna arises from a lumbar artery in most of cases. Therefore, the sacrifice of the intercostal arteries during a thoracic aorta repair could be justified, at least from an anatomical standpoint. However, if an extended thoracoabdominal aortic repair is planned, it may be prudent to preserve the blood flow from the lumbar arteries.
Biglioli
Paolo
P
Department of Cardiovascular Surgery, University of Milan, Centro Cardilogico Fondazione Monzino IRCCS, Italy.
Roberto
Maurizio
M
Cannata
Aldo
A
Parolari
Alessandro
A
Fumero
Andrea
A
Grillo
Francesco
F
Maggioni
Marco
M
Coggi
Guido
G
Spirito
Rita
R
D000368:Aged; D000369:Aged, 80 and over; D001012:Aorta, Abdominal / Q000033:anatomy & histology; D003097:Collateral Circulation / Q000502:physiology; D004791:Enzyme Inhibitors / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007558:Italy; D008159:Lumbar Vertebrae / Q000033:anatomy & histology / Q000098:blood supply*; D008297:Male; D008751:Methylene Blue / Q000008:administration & dosage; D008875:Middle Aged; D010477:Perfusion; D012039:Regional Blood Flow / Q000502:physiology; D013116:Spinal Cord / Q000033:anatomy & histology / Q000098:blood supply*; D013904:Thoracic Vertebrae / Q000098:blood supply; D014711:Vertebral Artery / Q000033:anatomy & histology
D004791:Enzyme Inhibitors; D008751:Methylene Blue