[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Anatomy](https://durgical.com/en/anatomy/) › [Spine](https://durgical.com/en/anatomy/region/spine/) › Artery of Adamkiewicz [Cardiovascular system](https://durgical.com/en/anatomy/system/cardiovascular-system/) · [Spine](https://durgical.com/en/anatomy/region/spine/) # Artery of Adamkiewicz The artery of Adamkiewicz is the largest artery feeding the lower [spinal cord](https://durgical.com/en/anatomy/spinal-cord/), usually entering on the left between T8 and L2. Official name: Great radicular artery [See in 3D →](https://durgical.app/?from=durgipedia&lang=en#region=spine&select=artery_of_adamkiewicz&side=r) Opens in the Durgical app, no sign-up needed. ## What it is The largest artery feeding the front of the lower spinal cord. It usually enters on the left between T8 and L2, but the level varies. ## What it does Supplies much of the lower two-thirds of the cord through the anterior spinal artery; injury can cause paralysis, so surgeons and radiologists take it into account. ## Key points - Main feeder of the anterior spinal artery for the lumbosacral enlargement; losing it can cause anterior spinal artery syndrome with paraplegia - Surgeons and radiologists try to locate it before thoracoabdominal aortic repair, stent-grafting, tumour embolization or anterior thoracolumbar [spine](https://durgical.com/en/anatomy/region/spine/) surgery - In anterior or lateral spine exposure the segmental vessels are tied at the middle of the vertebral body, away from the foramen, to spare collaterals that may feed it ## Key facts **Origin** Usually a left posterior intercostal or lumbar artery at T9–T12 (about 75%; varies T5–L2) **Branches** Great anterior segmental medullary artery; joins the anterior spinal artery with a hairpin turn **Supplies** Lower two-thirds of the cord via the anterior spinal artery (lumbosacral enlargement and conus) ## Relations **Course** From the dorsal (spinal) branch of a lower posterior intercostal or upper lumbar artery, usually on the left, it enters an intervertebral foramen with a spinal nerve, climbs along the ventral root and then turns sharply down to join the [anterior spinal artery](https://durgical.com/en/anatomy/anterior-spinal-artery/) ## How to find it It cannot be felt. It usually enters the canal on the left through a foramen between T9 and T12, climbs along the root and joins the anterior spinal artery with a sharp downward hairpin turn, the sign used to recognize it on spinal angiography or CT angiography. ## On imaging Spinal angiography with selective injection of the intercostal and [lumbar arteries](https://durgical.com/en/anatomy/lumbar-arteries/) is the reference; CT or MR angiography can often show it without a catheter as a thin vessel on the front of the cord with a hairpin turn. ## Clinical notes - Paraplegia after thoracoabdominal aneurysm repair or stent-grafting reflects lost flow through this artery and its collaterals; reimplanting intercostal arteries and draining cerebrospinal fluid are used to lower the risk - Embolization of spinal tumours, or of bronchial or intercostal arteries for bleeding, carries a risk of cord infarction if the artery shares a trunk with the target - Left-sided thoracolumbar approaches, segmental ligation and transforaminal injections at the lower thoracic and upper lumbar levels all take its usual position into account ## Anatomical variants - Arises on the right in roughly a quarter of people - Sometimes two large anterior feeders share its role instead of one dominant artery (some texts) ## Development Early on almost every segment sends a radicular artery to the cord; most regress, leaving a few larger anterior feeders, and this artery is usually the biggest of them. ## Related conditions - [Aortic dissection](https://durgical.com/en/conditions/aortic-dissection/) ## Test yourself Think of the answer, then tap the question to see it. ## Where does the artery of Adamkiewicz usually arise? From a left posterior intercostal or lumbar artery at T9–T12 in about 75% of people; the level varies from T5 to L2, and it is right-sided in about a quarter. ## What territory does the artery of Adamkiewicz supply, and through which vessel? The lower two-thirds of the spinal cord, including the lumbosacral enlargement and conus, by feeding the anterior spinal artery. ## What angiographic shape identifies the artery of Adamkiewicz on the front of the cord? A hairpin turn: it climbs along the ventral root and then turns sharply down to join the anterior spinal artery. ## What is the feared complication of losing the artery of Adamkiewicz in thoracoabdominal aortic repair? Paraplegia from anterior spinal artery syndrome; reimplanting intercostal arteries and draining cerebrospinal fluid are used to lower the risk. [Add to my cards (4)](https://durgical.app/estudiar/?add=/en/anatomy/great-radicular-artery/) Educational information, not medical advice. For any symptom, see a health professional. ## Its names **Official Latin (TA2)** arteria radicularis magna TA2 4536 **Official Spanish (DeCS)** Arteria radicular magna **English (TA2)** Great radicular artery **Also called** great segmental medullary artery ## Related - [Posterior intercostal arteries](https://durgical.com/en/anatomy/posterior-intercostal-arteries/) - [Anterior spinal artery](https://durgical.com/en/anatomy/anterior-spinal-artery/) - [Spinal cord](https://durgical.com/en/anatomy/spinal-cord/) - [Conus medullaris](https://durgical.com/en/anatomy/conus-medullaris/) Sources: Terminologia Anatomica (TA2); [Neuroanatomy, Spinal Cord Morphology](https://www.ncbi.nlm.nih.gov/books/NBK545206/). ## **Spotted a mistake?** We are always improving for the community. Tell us what is wrong and our team will review it. Report a mistake Representative model, for educational purposes only. --- Source: https://durgical.com/en/anatomy/great-radicular-artery/ License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/anatomy/great-radicular-artery/