title: Intraforaminal Location of Thoracolumbar Radicular Arteries Providing an Anterior Radiculomedullary Artery Using Flat Panel Catheter Angiotomography.
abstract: OBJECTIVE
  Flat panel catheter angiotomography performed during the selective injection of intersegmental arteries offers a multiplanar assessment of the intraforaminal course of the radicular arteries providing an anterior radiculomedullary artery. Injury of anterior radiculomedullary arteries during transforaminal epidural steroid injections can result in spinal cord damage. Evaluations of the intraforaminal location of these arteries have so far been limited to anteroposterior views or the examination of cadaveric material. This study documents the in vivo intraforaminal location of thoracolumbar arteries providing an anterior radiculomedullary artery with flat panel catheter angiotomography.
  
  
  METHODS
  Ninety-four flat panel catheter angiotomography acquisitions obtained during the selective injection of intersegmental arteries providing an anterior radiculomedullary artery were reviewed. Measurements obtained from sagittal reconstructions were converted into a scatterplot visualization. Patients' age, sex, and side and level of the injection were recorded.
  
  
  RESULTS
  The location of radicular arteries could be ascertained in 78 of 94 flat panel catheter angiotomography acquisitions (33 women and 45 men, 22-82 years of age). Fifty-three acquisitions (67.9%) were on the left side, and 25 (32.1%), on the right, between T2 and L3. The arteries were found in the anterosuperior quadrant of the neural foramen in 75 cases (96.2%), in the posterosuperior quadrant in 2 cases (2.6%), and in the anteroinferior quadrant in 1 case (1.3%). None were located in the posteroinferior quadrant. No differences in location were observed with age, sex, side of injection, or vertebral level.
  
  
  CONCLUSIONS
  Avoiding needle placement in the superior half of the neural foramen, specifically the anterosuperior quadrant, can reduce the risk of spinal cord injury during transforaminal epidural steroid injection.
authors.affiliation: From the Division of Interventional Neuroradiology (L.G., D.E.S., P.G.).|Department of Art as Applied to Medicine (L.G.), The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: L
authors.identifier: http://orcid.org/0000-0003-2227-7193
authors.initials: L
authors.lastname: Gregg
authors.affiliation: From the Division of Interventional Neuroradiology (L.G., D.E.S., P.G.).
authors.forename: D E
authors.identifier: http://orcid.org/0000-0003-4122-4791
authors.initials: DE
authors.lastname: Sorte
authors.affiliation: From the Division of Interventional Neuroradiology (L.G., D.E.S., P.G.) phg@jhmi.edu.
authors.forename: P
authors.identifier: http://orcid.org/0000-0003-0768-3273
authors.initials: P
authors.lastname: Gailloud
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001158:Arteries / Q000000981:diagnostic imaging*; D057785:Catheters; D000072226:Computed Tomography Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D007268:Injections, Epidural / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009339:Needles; D013116:Spinal Cord / Q000098:blood supply*; D055815:Young Adult