Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz): a retrospective review.
OBJECTIVE
The purpose of this study was to better characterize the intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz [AKA]) within the neural foramen that would allow safer targeting of thoracic and lumbar transforaminal epidural steroid injections.


METHODS
A retrospective review of conventional thoracic and lumbar spinal angiograms performed at the Mayo Clinic from 1998-2008 was conducted. Two hundred forty-eight patients were identified and their spinal angiograms reviewed. The cephalo-caudal location of the AKA within the foramen at the mid-pedicular plane was documented along with the side and level of the AKA.


RESULTS
From the 248 patients, 113 radiculomedullary arteries could be clearly evaluated within a neural foramen. The AKA was located in the superior one-half of the foramen in 97% (110). Eighty-eight percent (100) were located in the upper third; 9% (10) were located in the middle third; and 2% (2) were located in the lower third. The AKA was never seen in the inferior one-fifth of the foramen. Eighty-eight percent (100) of the radiculomedullary arteries were located on the left while 17% (20) were located on the right. The radiculomedullary arteries were identified from T2-L3. 92% (110) were located between T8 and L1. 28% (34) were located at T10, the highest incidence.


CONCLUSIONS
The AKA was overwhelmingly located in the superior aspect of the neural foramen. Contrary to traditional teaching, the safest needle placement for an epidural steroid injection, particularly at L3 and above, may not be in the superior aspect of the foramen, but rather in an inferior and slightly posterior position within the foramen and relative to the nerve.
Mayo Clinic and Foundation, Department of Radiology, Rochester, Minnesota 55905, USA. murthy.naveen@mayo.edu
Naveen S
NS
Murthy
Timothy P
TP
Maus
Curt L
CL
Behrns
D000792:Angiography / Q000379:methods; D001158:Arteries / Q000033:anatomy & histology*; D005471:Fluoroscopy / Q000379:methods; D006801:Humans; D007268:Injections, Epidural / Q000379:methods; D008161:Lumbosacral Region / Q000098:blood supply*; D011843:Radiculopathy / Q000188:drug therapy; D012189:Retrospective Studies; D013116:Spinal Cord / Q000098:blood supply; D013256:Steroids / Q000008:administration & dosage / Q000627:therapeutic use; D013904:Thoracic Vertebrae / Q000098:blood supply*
D013256:Steroids