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Vascular Anatomy 95

2.4 Spinal cord vasculature

See ▶ Fig. 2.13. Although a radicular artery from the aorta accompanies the nerve root at many lev-
els, most of these contribute little flow to the spinal cord itself. The anterior spinal artery is formed
from the junction of two branches, each from one of the vertebral arteries. It supplies blood to the 2
anterior 2/3 of the spinal cord (▶ Fig. 2.14). Branches include sulcal arteries which also supply the
anterior horns of the gray matter. Major contributions to the anterior spinal cord are from 6 –9 radic-
ular arteries in variable locations, which may include the following (“radiculomedullary arteries,”
the levels listed are fairly consistent, but the side varies20 (p 1180–1)):
1. C3—arises from vertebral artery
2. C6 and C8 (≈ 10% of population lack an anterior radicular artery in lower cervical spine21)
a) C6 —usually arises from deep cervical artery
b) C8—usually from costocervical trunk
3. T4 or T5
4. artery of Adamkiewicz AKA arteria radicularis anterior magna
a) the main arterial supply for the spinal cord from ≈ T8 to the conus
b) located on the left in 80%22

basilar artery
spinal cord

radicular artery at C3
anterior spinal artery
radicular artery at C6

right vertebral left vertebral deep cervical artery

artery artery
right common costocervical trunk
left common
carotid carotid radicular artery at C8
right
subclavian left subclavian

}
brachiocephalic trunk left posterior spinal artery
radicular artery at T5
aorta

posterior inter-
costal artery
(dorsal branch) intercostal arteries
posterior artery of
spinal arteries Adamkiewicz
radicular (arteria radicularis
artery anterior magna)
posterior arteria radicularis
intercostal magna
artery (posterior branch)
anterior
spinal
aorta artery
ANTERIOR

Axial view

Fig. 2.13 Schematic diagram of spinal cord arterial supply. (Modified from Diagnostic Neuroradiology, 2nd ed.,
Volume II, pp. 1181, Taveras J M, Woods EH, editors, © 1976, the Williams and Wilkins Co., Baltimore, with
permission.)
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96 Anatomy and Physiology

posterior spinal
vasocorona arteries

2
posterior
radicular
artery

anterior
radicular
artery

segmental
spinal artery

circumferential sulcal segmental

perforating artery medullary
spinal arteries artery from
anterior spinal aorta
artery

Fig. 2.14 Segmental blood supply to the spinal cord.

c) situated between T9 & L2 in 85% (between T9 & T12 in 75%); in remaining 15% between T5 &
T8 (in these latter cases, there may be a supplemental radicular artery further down)
d) usually fairly large, gives off cephalic and caudal branch (latter is usually larger) giving a char-
acteristic hair-pin appearance on angiography
The paired posterior spinal arteries are less well-defined than the anterior spinal artery, and are fed
by 10–23 radicular branches. Anastamotic vessels between the anterior and posterior spinal arteries
are called vasocorona.
The midthoracic region has a tenuous vascular supply (“watershed zone”), possessing only the
above noted artery at T4 or T5. It is thus more susceptible to vascular insults.

▶ Anatomic variants. Arcade of Lazorthes: normal variant where the anterior spinal artery joins
with the paired posterior spinal arteries at the conus medullaris.

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