Artery of Adamkiewicz

The artery of Adamkiewicz, also known as the great anterior radiculomedullary artery or arteria radicularis anterior magna, is the name given to the dominant thoracolumbar segmental artery that supplies the spinal cord.

Gross anatomy

Origin

The artery of Adamkiewicz has a variable origin but most commonly arises ¹:

• on the left (~80%)
• at the level of the 9^th-12^th intercostal artery (~70%)

It arises from the radiculomedullary branch of the posterior branch of the intercostal or lumbar artery, which arises from the thoracic or abdominal aorta respectively ¹. It has a diameter of ~1 mm (range 0.8-1.3 mm) ^1,4. 

Course

• ascends on the mid-sagittal anterior surface of the spinal cord, usually less than two-and-a-half vertebral body lengths, with an identifying "hairpin turn" at its anastomosis with the anterior spinal artery ^1,2,4
• 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.