Percutaneous embolisation of major spinal cord artery as a treatment for intractable spasticity

Based on the angiographic findings of the injured spinal cord percutaneous embolisation of Adamkiewicz's artery was carried out to control intractable spasticity in ten cases of late stage spinal cord paralysis. The purpose of this procedure was to interrupt the reflex arcs of the lower extremities by decreasing the blood supply to the lumbar enlargement. Results were excellent in two cases, good in five and poor in three. Major effects were found in adduction and flexion spasticity of the hip joints and bladder function was always preserved in these patients. It is speculated that occlusion of Adamkiewicz's artery mainly affected the lower thoracic and the upper lumbar segments. Anastomosis between the anterior spinal artery and the two posterior spinal arteries might have provided sufficient collateral blood circulation to the conus level. It is emphasised that the percutaneous embolisation of Adamkiewicz's artery reduced the intractable spasticity of the lower extremities without changes in the voiding function of the automatic bladder.