Artery of Adamkiewicz

The artery of Adamkiewicz, also known as the great anterior radiculomedullary artery or arteria radicularis anterior magna, is the name of the dominant thoracolumbar segmental medullary artery, which supplies the lower spinal cord by reinforcing the anterior spinal artery.

Gross anatomy

The artery of Adamkiewicz is found in 85% of people and, when present, is usually single (87%) ⁶. It has a diameter of ~1 mm (range 0.8-1.3 mm) ^1,4.

Origin

The artery of Adamkiewicz most commonly arises at the level of the lower thoracic or upper lumbar vertebrae (between the T8-L1 levels in 89%, between the T7-L2 levels in 95%), with a striking left sided predominance (77%) ⁶. However, origins from either side and any level from T3 to L4 have been reported ⁶. As a radiculomedullary artery, it arises from the spinal branch of the dorsal branch (posterior ramus) of the segmental artery (posterior intercostal, subcostal, or lumbar artery), which in turn arises from the descending aorta ¹.

Course

• ascends on the mid-sagittal anterior surface of the spinal cord, usually less than two-and-a-half vertebral body lengths
• takes a characteristic "hairpin turn" at its anastomosis with the anterior spinal artery ^1,2,4
• otherwise has a straight course, compared to the anterior radiculomedullary vein, which is more tortuous ⁴

Branches and supply

• anastomosis with the anterior spinal artery, supplying arterial blood to the spinal cord from T8 to the conus medullaris ³

Variant anatomy

As outlined above the origin of the artery of Adamkiewicz is quite variable and can extend from mid-thoracic to lumbar levels ³:

• lumbar arteries at the level of L1 or L2 (10%)
• intercostal arteries at the level of T5 to T8 (15%)
  • may arise from intercostobronchial trunk (ICBT)
    • thus bronchial artery embolization must be done very carefully in such cases
• arises on the right (20%)

Radiographic features

CT

On CTA, it appears as a continuous vascular structure running from an intercostal or lumbar artery to the anterior spinal artery via the radiculomedullary artery with its characteristic course ².

Related pathology

The distal anterior spinal cord vascular territory is at risk of ischemia or infarction if there is damage to the artery of Adamkiewicz from pathology (e.g. AAA, dissection, malignancy, vascular malformations) or intervention (e.g. AAA repair, spinal surgery, angiography) ^1-2.

History and etymology

It is named after Albert Wojciech Adamkiewicz (1850-1921), a Polish physician and neuropathologist ⁵.