A 70-year-old patient undergoes an aortic aneurysm repair. Postoperatively the patient develops paraplegia. The anterior spinal artery supplies the anterior two-thirds of the spinal cord. The largest radiculomedullary artery reinforcing the anterior spinal artery in the thoracolumbar region is:

• A Artery of Adamkiewicz (arteria radicularis magna) — typically from T9–L2 on the left ✓
• B Posterior intercostal artery at T4
• C Lateral sacral artery
• D Lumbar artery at L5

Explanation

The artery of Adamkiewicz (great anterior segmental medullary artery / arteria radicularis magna) is the largest contributor to the anterior spinal artery and supplies the lower two-thirds of the spinal cord. It arises from a posterior intercostal or upper lumbar artery, most commonly between T9 and L2, and is left-sided in approximately 75–80% of cases. Sacrifice during aortic surgery (cross-clamping or ligation of intercostal arteries in this segment) risks anterior spinal artery syndrome: paraplegia with preserved posterior column function. Preserving reimplantation of these intercostal arteries is a surgical priority.

Reference: BD Chaurasia's Human Anatomy, 8th ed.

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Written and medically reviewed by the StethoPrep medical team.