A 54-year-old man undergoing abdominal aortic surgery wakes with flaccid paraplegia and complete loss of pain and temperature sensation below the umbilicus. Vibration sense, joint position sense, and light touch in both legs are entirely normal. Which vessel was most likely compromised?

• A Posterior spinal arteries
• B Anterior sulcal branches supplying the posterior columns
• C Radicular branches of the segmental medullary arteries supplying the posterolateral cord
• D Anterior spinal artery via the artery of Adamkiewicz ✓

Explanation

The anterior spinal artery supplies roughly the anterior two thirds of the cord, including the corticospinal tracts and the spinothalamic tracts, while the paired posterior spinal arteries supply the dorsal columns. Occlusion therefore abolishes motor function and pain temperature sensation but spares vibration, proprioception, and fine touch. The major radiculomedullary feeder, the artery of Adamkiewicz, arises on the left between T9 and L2 and is vulnerable during aortic cross-clamping. Option B is impossible because the anterior sulcal branches never reach the posterior columns.

Reference: Gray's Anatomy for Students, 4th ed.

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Written and medically reviewed by the StethoPrep medical team.