PREOPERATIVE LOCALISATION OF THE ADAMKIEWICZ ARTERIA IN SPINE SURGERY

Abstract

Introduction: The lumbosacral medulla is vascularized by the Adamkiewicz arteria which irrigates the anterior spinal arteria. Occlusion or section of the Adamkiewicz arteria may induce an ischemia of the medulla during anterior or transforaminal spine surgery. An angiography allows to determine the exact topography of this artery. The purpose of this study was to describe its preoperative topography and to analyze the impact of angiography on the surgical strategy.

Methods: In this retrospective study, 100 preoperative medullar angiographies, performed by a vascular radiologist between january 1998 and august 2007, were reviewed. Surgical indications were: 50 vertebrectomies in tumors, 20 anterior fusions in dorsolumbar fractures, 10 anterior fusions in malunions, 10 anterior releases in scoliosis, 3 transpedicular osteotomies, 7 disc hernias (T7-L4). The level and the side of foraminal entrance of the Adamkiewicz arteria and collateral arterias irrigating the anterior spinal arteria were analyzed. We looked for the occurence of postoperative ischemic signs of the medulla. Modifications of surgical planning because of Adamkiewicz’ arteria topography were noted. The possibilities of preoperative tumor embolisation were analyzed.

Results: The Adamkiewicz arteria was always localized between T8 and L3. It was present at the foraminal levels L1/L2 or L2/L3 in 48% of the cases. The left side was concerned in 65% of the cases. A modification of the surgical strategy was noted in 16% of the cases: 12 side changements of operative approach, 4 contra-indications for anterior surgery. An ischemic syndrome of the anterior lumbosacral medulla were not found. In the group of tumors, the preoperative angiography allowed to perform a selective embolisation of tumor vessels in 80% of the cases. In all other cases, the tumor vascularisation was common with the vascularisation of the medulla which could have made the embolisation dangerous.

Conclusion: Although the occurence of a lumbosacral medullar ischemia secondary to an Adamkiewicz arteria lesion is rarely reported in the literature, the preoperative angiography reduces this potential risk. The exact knowledge of the anterior medullar vascularisation allows to better plan the surgical strategy and to adapt the side of operative approach. Furthermore, the angiography enables to perform a selective embolisation of tumors safely.