Spinal angiology
Last reviewed: 23.04.2024
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Within the framework of this article, we limited ourselves to only some basic information on the problem of spinal angiology. Questions of blood supply to the spine and spinal cord, as well as related pathology, are fully fully reflected in the anatomical and neurological literature published in the Russian language as well. Let us only point out that the basic, domestic works are the works of D.K. Bogorodinsky and A. A. Skorets, et al. (1965-1998), and foreign - G. Lazorthes et al. (1973) and WH Hollinshead (1982). From these works we have borrowed practically all the data given below.
Segmental arteries, the branches of which provide blood supply to the thoracic and lumbar spinal cord and vertebrae, depart directly from the thoracic and abdominal aorta. In the cervical segmental arteries move away from the vertebral arteries. After dividing the dorsal artery into the posterior musculo-dermal and spinal arteries, the latter, together with the spinal cord, penetrate the vertebral canal. The section of the artery accompanying the spinal root is called the radicular artery. Part of the arteries entering the vertebral canal with their terminal branches terminate in the membranes of the spinal cord (radiculo-meningeal arteries), and only one of every four or five radicular arteries directly reaches the spinal cord (radiculo-medullary arteries). It should be noted that in the thoracic region the number of radiculo-medullary arteries is the least in comparison with other parts of the spinal cord.
Depending on the number of arteries reaching the tissue of the spinal cord, K. Jellinger (1966) identified two types of main spinal blood flow - segmental ("poorly segmented") and plurisegmentary. In the first case, the blood supply to the spinal cord is provided by two or three radiculo-medullary arteries, in the second - their number is 5.6 or more.
Knowledge of the anatomical features of the blood flow, both along the length and the width of the spinal cord, allows a fairly accurate definition of the zone of spinal ischemia, which is of fundamental importance in the analysis of clinical manifestations of vascular diseases of the spinal cord.
Knowledge of the anatomical features of the blood supply to the spinal cord allows us to accurately determine the zone of vascular disorders of the spinal cord, accompanied by pathological clinical symptoms.
Summary of data on arterial spinal pools
|
Authors |
Arterial pools of the spinal cord |
| Zulch KJ (1954), Lazorthes G. Et al. (1957), CorbinJ.L. (1961) | The upper, intermediate and lower basins correspond to the basic scheme of arterial blood flow. |
| Bogorodinsky DK, Skoromets AA with et al. (1964, 1966, 1975), Jelling K. (1966) | The upper subclavian-cervical-invertebral basin (oral pool according to K. Jellinger) consists of vertebral and other proximal branches of the subclavian arteries (aa. Cervicalis, ascendens et profunda, intercostalis suprema), provides blood supply to all cranial segments to D2. |
|
Maliszewski M. (1994) |
The lower aortic basin (caudal basin according to K. Jellinger) is formed aa. Intercostales, subcostalis, lumbales, lumbales ima, iliosacrales, sacrales laterales et media; provides blood supply to all spinal segments below D2. Upper zone - C1-C3; middle zone - C4-C5; cervical thickening - C5, -C7 ,; upper thoracic zone - D1-D3; middle chest zone - D4-D12; thoracolumbar thickening - D8-L5, lumbosacral zone - L5-Co. |
Anatomical variants of the lower arterial basin (according to AA Skoromets, et al., 1998)
|
Anatomical variant |
Variant features |
Frequency of occurrence |
|
I |
With one large radiculo-medullary artery of Adamkiewicz |
20.8% |
|
II |
With the artery of Adamkiewicz and the lower additional radiculo-medullary artery (followed by the lower lumbar or 1 sacral spine and corresponds to the artery of Deprozh-Gotteron) |
16.7% |
|
III |
With the artery of Adamkiewicz and the upper additional radiculo-medullary artery (followed by one of the rootlets from T3 to T6) |
15.2% |
|
IV |
Spatial type (plurisegmentary type according to KJelliger) - brain nutrition is provided by three or more radiculo-medullary arteries |
47.2% |
It is important to emphasize that vascular spinal disorders can be observed not only in diseases of the spinal cord, but also in vertebral-spinal cord injury. In this case, clinical manifestations of damage are accompanied by pathological neurological symptoms, the treatment of which requires not surgical intervention, but active vasotropic therapy.
We consider it necessary in this article to repeat those features of manifestations of vascular pathology in vertebral-spinal trauma, which draw attention to. Bersnev et al. (1998):
- discrepancy of the upper level of spinal disorders to the level of spine trauma. As a rule, pathological neurological symptoms are detected in zones innervated by spinal segments located above the level of traumatized vertebral segments. F. Denis calls this pathology an upward traumatic myelopathy - myelopathy ascendens;
- the prevalence of the spinal cord of the anterior (motor) disorders - fasciculations and fibrillations, amyotrophy, atony, areflexia, along the length of the spinal cord, and also the detection of these signs in zones corresponding to a particular vascular pool;
- rapid transient repetitive motor disorders, the presence of which is characteristic of the transient compression of the major vessels of the spinal cord.
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