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Spinal Cord Disease
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
Along its discontinuous course below T4, it receives segmental input from six to nine intercostal radicular arteries arising from the aorta. The major radicular artery, the great ventral radicular artery or artery of Adamkiewicz, arises usually on the left, variably from T9 to T12, or less commonly anywhere from T5 to L2, and supplies the lumbar cord and conus medullaris. At the lumbosacral level, radicular arteries are derived from larger regional vessels, the largest of which enters the intervertebral foramen at L2 to form the lowermost portion of the anterior spinal artery (the terminal artery) which runs along the filum terminale.
Spinal Cord Angiography
Published in Milosh Perovitch, Radiological Evaluation of the Spinal Cord, 2019
An interruption of the blood flow in an important radicular artery will produce infarction, particularly in the vulnerable “watershed zones”, at the distal or proximal end of the territory involved. An infarct can be found several segments above or below the occluded artery. A more distal part of the spinal cord, supplied independently of the obstructed artery, will survive without being affected by the infarction. Occlusion of a radicular artery will produce a central necrosis of the spinal cord that can extend over several segments and cause clinical symptoms similar to the occlusion of the anterior spinal artery.68 Occlusion of an anterior sulcal artery that provides blood only to one half of the spinal cord may cause a Brown-Séquard syndrome.69, 73, 74
The spine
Published in Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie, Bailey & Love's Short Practice of Surgery, 2018
Professor Sir Norman Williams, Professor P. Ronan O’Connell, Professor Andrew W. McCaskie
The blood supply of the spinal cord is derived from the vertebral, deep cervical, intercostal and lumbar arteries. The arteries of the spinal cord include the anterior spinal artery and two posterior spinal arteries, with the anterior spinal artery supplying the majority of the vascular supply to the spinal cord. The radicular artery of Adamkiewicz makes a major contribution to the anterior spinal artery, supplying the lower spinal cord. It originates on the left in 80% of people, usually accompanying the ventral root of T9, T10 or T11, but can originate anywhere from T5 to L5. Ligation of this important artery may lead to critical ischaemia of the spinal cord. Ligating segmental vessels over the midpoint of the vertebral body will minimise the risk of injury to this important artery during anterior approaches to the spine.
Clinically suspected fibrocartilaginous embolism: a case report and literature review
Published in International Journal of Neuroscience, 2022
Wencan Ke, Chao Chen, Shuai Li, Bingjin Wang, Saideng Lu, Cao Yang
As for acutely progressive spinal cord symptoms, FCE is a rare but possible cause of SCI. It is generally agreed that an acute vertical disc herniation can lead to SCI via entry of disc material into the vasculature of the spinal cord; however, the mechanism whereby disc fragments enter the vessels is unclear. One hypothesis is that the disc ruptures laterally, with penetration of disc material into an adjacent radicular artery [4]. An alternative hypothesis is intervertebral disc herniation through the vertebral endplate (Schmorl nodes) and hence into the vertebral bone marrow, with the embolus entering the spinal cord circulation [7]. Although definitive diagnosis of FCE can be confirmed only histologically and usually at autopsy, the risks of histologic confirmation are too great. Currently, there are no noninvasive tests to confirm a diagnosis of FCE. However, a clinical diagnosis of FCE can be extremely useful, as it may help to improve the patients’ clinical care and prognosis.
Spontaneous disappearance of a spinal dural arteriovenous fistula
Published in British Journal of Neurosurgery, 2020
Ghassan Kerry, Alexander Hammer, Claus Ruedinger, Hans-Herbert Steiner
The etiology of SDAVF is poorly understood; Rosenblum et al.4 suggested that SDAVFs are acquired lesions. They result in direct communication between a radicular artery and a vein within the dura matter, retrograde drainage into perimedullary veins and in some cases venous hypertension, which eventually causes a progressive extracellular edema, chronic hypoxia and congestive myelopathy.1–4 Treatment of venous hypertension can arrest the progression of symptoms with a good prognosis for recovery. Spontaneous disappearance of non-traumatic SDAVF is rare. We found 2 reported cases, both of which suggested spontaneous thrombosis as the cause for the disappearance.7,8 Meder et al.7 suggested diabetes mellitus as a factor promoting thrombosis of the SDAVF. In our case, we are assuming spontaneous thrombosis is the immediate cause but cannot say what provoked it.
C7 transfer in a posterior intradural approach for treating hemiplegic upper-limbs: hypothesis and a cadaver feasibility study
Published in British Journal of Neurosurgery, 2019
Su Jiang, Wei Chen, Yun-Dong Shen, Yan-Qun Qiu, Ai-Ping Yu, Wen-Dong Xu
Compared with the prespinal route, an advantage of the posterior intradural approach is that it is more direct, with no requirement to dissect or tunnel through tight spaces. In the prespinal route, the donor and recipient nerve roots must be tunneled under the carotid sheath, the thyroid, and the trachea and esophagus. Related risks include deep infections, carotid plaque detachment, laryngeal nerve palsy, sympathetic nerve dysfunction, tracheo-esophageal rupture and even vertebral artery injury,8 which can result in serious bleeding and perhaps a brainstem stroke.8 These risks can be avoided by using the posterior intradural approach. Posterior cervical operations also preserve the sympathetic chain as well as avoiding injury to the anterior cervical radicular artery, which might cause a spinal cord infarct.20