21 Blood Supply of the Cord

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Blood Supply of

the Spinal Cord


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ArterialSupplyoftheSpinal

CordThe arterial supply of the spinal cordby the vertebral arteries.

It is also from the branches ultimatelyfrom the thoracic and abdominal aorta,called the radicular arteries.

Each vertebral artery (or posteriorinferior cerebral artery) gives rise to a

posterior spinal artery, which proceedsalong the line of attachment of thedorsal roots.


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Cord Each vertebral artery also gives rise to an anterior

spinal artery.

The 2 anterior spinal arteries fuse to form a singlemidline vessel.

This courses along the anterior median fissure ofthe spinal cord.


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Cord

The posterior spinal arteries and theanterior spinal artery supply uppercervical levels with from the vertebralarteries.

Below this, all 3 spinal arteries form amore or less continuous series ofanastomoses with radicular arteries.


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CordBeginning with lower cervical segments,the spinal cord depends on theradicular arteries for its survival.

The great radicular artery (ofAdamkiewicz), present at the spinalcord level T12-L2 may provide theentire arterial supply for the caudal 2/3

of the spinal cord.


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Cord

The very long anterior spinal artery is usually acontinuous vessel for the length of the spinal cord.


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Cord It gives rise to hundreds ofcentral and

circumferential branches.

These supply the anterior 2/3 of the spinal cord. This includes the base of the posterior horn and a

variable portion of the lateral corticospinal tract.


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Cord

The posterior spinal arteries are really more of aplexiform network of small arteries.

They supply the posterior columns,substantia gelatinosa, dorsal root entry zone, anda variable portion of the lateral corticospinal tract.


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AnteriorCordSyndrome

Anteriorcordsyndromeisveryrareandinvolvestheanteriortwothirdsofthespinalcord,leavingonlytheposterior

columnsintact.

Itmostcommonlyfollowsavascularinsultsuchasagreatvesselinjury,vertebralbodyfracture,oranteriorspinalcanalocclusivetumors.


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Pa=entsusuallypresentwithanacutelossofmotorandmostsensoryfunc=onbelowtheleveloftheinjury.

Bowelandbladderfunc=onisusuallyaffectedbecauseofalossofsensoryinput.


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Sparingoftheposteriorcolumnspreservessomedeeppressure,vibratory,andlighttouchsensa=on.

Theprognosisforrecoveryinthissyndromeisverylimited4.


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PosteriorCordSyndrome

Affectstheposteriorcolumn,dorsalroots,&partoflateralcor=cospinaltract

Dorsalroots Lossofallsensoryinnerva=onattheinvolvedsegment

Posteriorcolumn Vibra=on,Propriocep=on,stereognosis,2-pointdiscrimina=on,andfinetouchlossonbothsidesbelowtheinvolvedsegment

Partofcor=cospinaltract Varyingdegreesofmuscleweakness


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21 Blood Supply of the Cord

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