Artery of Adamkiewicz

Last revised by Francis Deng on 2 Apr 2021

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.

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.

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.

  • 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

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)
  • arises on the right (20%)

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.

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.

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

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Cases and figures

  • Case 1: occlusion by aortic dissection
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  • Case 2: with spinal AVM
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