Unusual origin of the artery of Adamkiewicz from the fourth lumbar artery

• Published in: Neuroradiology Vol. 44; no. 2; pp. 153 - 157
• Main Authors: LO, D, VALLEE, J. N, SPELLE, L, CORMIER, E, SAILLANT, G, RANCUREL, G, CHIRAS, J
• Format: Journal Article
• Language: English
• Published: Berlin Springer 01.02.2002; Springer Nature B.V
• Subjects: Adult; Arteries - abnormalities; Arteries - anatomy & histology; Biological and medical sciences; Female; Humans; Lumbar Vertebrae - abnormalities; Lumbar Vertebrae - anatomy & histology; Lumbar Vertebrae - diagnostic imaging; Magnetic Resonance Imaging; Male; Medical sciences; Middle Aged; Neurology; Radiography; Spinal Cord - blood supply; Spinal Cord - diagnostic imaging; Vascular diseases and vascular malformations of the nervous system; Human; Postoperative; Nervous system diseases; Radiodiagnosis; Angiography; Lumbar artery; Cardiovascular disease; Male; Congenital disease; Arterial disease; Vascular disease; Case study; Vascular lesions of the spinal cord; Ischemia; Malformation; Central nervous system disease; Adult; Complication; Female; Diagnosis; Spinal cord disease
• ISSN: 0028-3940; 1432-1920
• DOI: 10.1007/s002340100658

The main arterial supply of the dorso-lumbar spinal cord is usually derived from a single anterior radiculo-medullary artery called the artery of Adamkiewicz and referred to as having a middle or low location. In some cases, the artery origin is higher, and a vessel which arises in the lower part of the region supplements the supply of the anterior spinal artery. In the literature, those arteries have been described as arising from L3 upwards, and have never been previously described angiographically, to our knowledge, below this level, although Suh and Alexander and Gililan have mentioned this eventuality. Of the 4,000 spinal cord angiographies performed in our institution, we report three cases in which the fourth lumbar artery flows into the anterior spinal artery of the conus medullaris. This anatomical variant may explain the sometimes devastating post-operative neurological complications from a spinal cord infarction on surgery of the lumbar spine or the abdominal aorta below L3.