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Does interruption of the artery of Adamkiewicz during total en bloc spondylectomy affect neurologic function?
Hideki Murakami1, Norio Kawahara, Katsuro Tomita
1Department of Orthopaedic Surgery, Kanazawa University, Kanazawa, Japan. hmuraka@med.kanazawa-u.ac.jp
Study Design:
A retrospective review of patients with interruption of the artery of Adamkiewicz during total en bloc spondylectomy (TES).
Objective:
To assess neurologic function after interruption of the artery of Adamkiewicz in TES.
Summary Of Background Data:
The most important feeding artery of the thoracolumbar spinal cord is the great anterior radiculomedullary artery, also called the artery of Adamkiewicz. The artery of Adamkiewicz supplies the lower two-thirds of the spinal cord via the anterior spinal artery. It is naturally believed among spine surgeons that interruption of the artery of Adamkiewicz during surgeries is absolutely contraindicated. However, it is necessary to sacrifice the artery of Adamkiewicz during TES, when the tumor, by chance, exists at the level of the artery of Adamkiewicz.
Methods:
Between 1990 and 2009, we have performed 180 cases of TES. All cases except for few emergency cases received preoperative embolization. The artery of Adamkiewicz was verified by angiography of the segmental arteries. There were 15 patients in which the artery of Adamkiewicz was found at the levels of resected vertebrae. Interruption of the artery was performed during surgery in these 15 cases. Neurologic function was analyzed retrospectively.
Results:
Of the 15 patients, the Frankel grade before surgery was C in 1, D in 5, and E in 9. At follow-up, the Frankel grade was D in 1 and E in 14. There were no cases of neurologic deterioration or paralysis after TES.
Conclusion:
On the basis of our results of TES on up to 3 vertebrae, interruption of the artery of Adamkiewicz for TES does not adversely affect neurologic function. We advocate strongly that our surgeons are allowed to sacrifice up to 3 pairs of segmental arteries, even including the artery of Adamkiewicz, if necessary.
