Relevance of the anatomical location of the Adamkiewicz artery in spine surgery.
OBJECTIVE
The aim of this study was to describe the preoperative topography of the Adamkiewicz artery and the blood supply of the lumbosacral spinal cord in patients who underwent spinal surgery. The relevance for anterior approaches of the thoracolumbar spine was then analyzed.


METHODS
One hundred consecutive spinal angiographies were reviewed. Surgical indications were: 26 vertebrectomies, 30 anterior fusions in fractures, 13 malunions, 16 anterior releases in scoliosis, 11 pedicle subtraction osteotomies and 4 thoracic disc hernias. The level and the side of the Adamkiewicz artery and the presence of additional radiculomedullary arteries were determined. Modifications of surgical planning owing to the Adamkiewicz artery were analyzed.


RESULTS
The Adamkiewicz artery was always located between T8 and L3, at T9 or T10 in 50%, and coming from the left side in 75% of the cases. Additional radiculomedullary arteries were found in 43% of the cases. A concordance between the topography of the Adamkiewicz artery and the planned surgical approach was noted in 15%, which led to ten side changings and three modifications of surgical technique with segmental vessel preservation. An ischemic syndrome of the anterior spinal cord did not occur.


CONCLUSIONS
Spinal cord ischemia is rarely reported after segmental vessel ligation. Spinal angiography allows determining the topography of the Adamkiewicz artery safely. If the planned surgical approach is located at the same level, a contralateral approach or selective surgical techniques without vessel ligation could avoid possible damage to the Adamkiewicz artery if the pathology does not dictate the side and the extent of the surgical approach.
Charles
Yann Philippe
YP
Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, 1 Place de l'Hôpital, BP 426, 67091 Strasbourg Cedex, France. yann.philippe.charles@chru-strasbourg.fr
Barbe
Bruno
B
Beaujeux
Rémy
R
Boujan
Fazel
F
Steib
Jean-Paul
JP
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000098:blood supply* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013116:Spinal Cord / Q000098:blood supply*; D016103:Spinal Fractures / Q000601:surgery; D013904:Thoracic Vertebrae / Q000098:blood supply* / Q000601:surgery; D055815:Young Adult