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Vulnerability of great medullary artery
1Department of Orthopaedic Surgery, Neurosurgery, and Anatomy Medical College of Ohio, Toledo, USA.
Study Design:
The present study describes anatomic observations on great medullary artery and intercostal arteries pertinent to thoracolumbar spinal surgery.
Objectives:
This study reveals the vulnerable course of the great medullary artery and its relationship to the lateral or posterolateral approach to thoracic spine.
Summary Of Background Data:
There are no previous anatomic data on the length of the great medullary artery, its intradural course, its relationship with the anterior spinal artery, and the distance between two adjacent intercostal arteries.
Methods:
The location of the intercostal arteries was defined, and the distance between two adjacent arteries was measured at a point on the lateral surface of the vertebra midway between its anteroposterior diameter. The intradural length of the great medullary artery and the angle it formed with the anterior spinal artery at the point of anastomosis were also measured.
Results:
The mean intradural length of the great medullary artery was 3.6 cm (range, 1.7-8.1 cm), and it passed over 1-3 disc spaces before joining the anterior spinal artery at a mean angle of 20.1 degrees (range, 12-28 degrees). The average distance between two adjacent intercostal arteries from T6 to L2 was 3.6 cm (range, 2.8-4.0 cm), which provides a safe window through which a herniated thoracic disc may be approached if surgery is indicated.
Conclusions:
The acute angle between the great medullary artery and anterior spinal artery indicates that these two arteries are in close proximity for considerable length and are liable to be compressed together with the intervening vascular collaterals by a space-occupying lesion, such as disc herniation or a fractured fragment. The longer the intradural course of the great medullary artery, the more vulnerable it is to compression by disc herniation or fracture. The intercostal and lumbar arteries are located at the midportion of the lateral aspect of the vertebral bodies rather than at the level of intervertebral discs. Discectomy or decompression of the anterior thoracic canal may be accomplished through a lateral or posterolateral extracavitary approach between two intercostal or lumbar arteries.