Document Detail

Intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz): a retrospective review.
MedLine Citation:
PMID:  21134118     Owner:  NLM     Status:  MEDLINE    
PURPOSE: The purpose of this study was to better characterize the intraforaminal location of the great anterior radiculomedullary artery (artery of Adamkiewicz [AKA]) within the neural foramen that would allow safer targeting of thoracic and lumbar transforaminal epidural steroid injections.
MATERIAL AND METHODS: A retrospective review of conventional thoracic and lumbar spinal angiograms performed at the Mayo Clinic from 1998-2008 was conducted. Two hundred forty-eight patients were identified and their spinal angiograms reviewed. The cephalo-caudal location of the AKA within the foramen at the mid-pedicular plane was documented along with the side and level of the AKA.
RESULTS: From the 248 patients, 113 radiculomedullary arteries could be clearly evaluated within a neural foramen. The AKA was located in the superior one-half of the foramen in 97% (110). Eighty-eight percent (100) were located in the upper third; 9% (10) were located in the middle third; and 2% (2) were located in the lower third. The AKA was never seen in the inferior one-fifth of the foramen. Eighty-eight percent (100) of the radiculomedullary arteries were located on the left while 17% (20) were located on the right. The radiculomedullary arteries were identified from T2-L3. 92% (110) were located between T8 and L1. 28% (34) were located at T10, the highest incidence.
CONCLUSIONS: The AKA was overwhelmingly located in the superior aspect of the neural foramen. Contrary to traditional teaching, the safest needle placement for an epidural steroid injection, particularly at L3 and above, may not be in the superior aspect of the foramen, but rather in an inferior and slightly posterior position within the foramen and relative to the nerve.
Naveen S Murthy; Timothy P Maus; Curt L Behrns
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Publication Detail:
Type:  Journal Article; Review     Date:  2010-09-07
Journal Detail:
Title:  Pain medicine (Malden, Mass.)     Volume:  11     ISSN:  1526-4637     ISO Abbreviation:  Pain Med     Publication Date:  2010 Dec 
Date Detail:
Created Date:  2010-12-07     Completed Date:  2011-03-14     Revised Date:  2011-11-30    
Medline Journal Info:
Nlm Unique ID:  100894201     Medline TA:  Pain Med     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1756-64     Citation Subset:  IM    
Copyright Information:
Wiley Periodicals, Inc.
Mayo Clinic and Foundation, Department of Radiology, Rochester, Minnesota 55905, USA.
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MeSH Terms
Angiography / methods
Arteries / anatomy & histology*
Fluoroscopy / methods
Injections, Epidural / methods
Lumbosacral Region / blood supply*
Radiculopathy / drug therapy
Retrospective Studies
Spinal Cord / blood supply
Steroids / administration & dosage,  therapeutic use
Thoracic Vertebrae / blood supply*
Reg. No./Substance:
Comment In:
Pain Med. 2011 Oct;12(10):1576; authr reply 1577   [PMID:  22018029 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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