Radiculomedullary arterial contributions to the thoracolumbar spinal cord: an angiographic study

Abstract

Background: Anterior (ASA) and posterior spinal arteries (PSA) receive vital collateral flow from radiculomedullary (RM) arteries. The purpose of this study was to review a series of spinal angiograms in order to characterize normal RM arterial anatomy.

Methods: The reports of digital subtraction spinal angiograms from consecutive patients from our institution from 2002-2019 were retrospectively reviewed. The RM contributions to both the ASA and PSA were characterized by noting laterality, spinal level and multiplicity.

Results: Overall, 336 spinal angiograms from 336 patients were included. Regarding RM input to the ASA, 328 patients (97.6%) had at least one RM contribution to the ASA. Forty-six patients (46/328, 14.1%) had multiple RM ASA contributions. Three hundred and eighty-one total RM with input to the ASA were visualized. Ninety-five RM of the ASA (95/381, 24.9%) were located on the right, 286 (75.1%) on the left. Three hundred and twenty-four RM arteries (85.0%) arose between T8 and L2: 246 (64.5% overall) were located on the left, and 78 (20.5%) on the right. Sixty-one patients (18.2%) had at least one visualized RM contribution to the PSA: 16 patients (16/61, 26.2%) had more than one RM contribution to the PSA. Eighty-seven total RM contributions to the PSA were visualized. Eighty-one (93.1%) RM arose between T6 and L1, 52 of which (59.8% overall) were from the left, and 29 (33.3%) from the right.

Conclusions: RM anastomoses with both the ASA and PSA most-commonly originate from the left-sided T6-L2 spinal levels. Multiple RM contributions to the ASA or PSA are less common.