BLOOD SUPPLY OF SPINAL CORD

Arterial Supply of spinal cord is via three arteries
- Spinal Arteries : Anterior (1) & Posterior (2) Spinal Artery from Vertebral artery.
- Radicular Arteries : Segmental arteries from Vertebral, Ascending Cervical, Intercostal and Lumbar Artery.

1. VASCULAR SUPPLY OF VASCULAR SUPPLY OF
SPINAL CORDSPINAL CORD

DR LOMESH WANKHEDE

2. Arterial Supply of spinal cord is via three arteries
- Spinal Arteries : Anterior (1) & Posterior (2)
Spinal Artery from Vertebral artery
- Radicular Arteries : Segmental arteries
from Vertebral, Ascending Cervical, Intercostal and
Lumbar Artery

4. Spinal Cord Blood Supply
Anterior Spinal
Artery, provides
sulcal branches
which penetrate the
ventral median
fissure and supply
the ventral 2/3 of
the spinal cord.
Posteroir spinal Posteroir spinal
arteries supply the arteries supply the
posterior columns, posterior columns,
substantia substantia
gelatinosa, dorsal gelatinosa, dorsal
root entry zone, root entry zone,
and a variable and a variable
portion of the portion of the
lateral lateral
corticospinal tract.corticospinal tract.

6. Paired anterior spinal arteries unite
to form a single descending vessel
(ie, anterior spinal artery) which
enters the anterior median fissure
of the spinal cord and supplies the
anterior two thirds of the cord. It
has smaller penetrating and
circumferential branches
Distribution:
a. supplies the ventral 2/3 of the
spinal cord which include
corticospinal tract, anterior horn
cells & spinothalamic tract.

7. •It begins to taper until it is resupplied by a major radicular
artery. It is smallest in the area of T4 to T8.
•It has 6 to 10 arterial feeders –radicular arteries

8. •Sulcal branches of the anterior
spinal artery penetrate the cord
in the depth of the sulcus and
each artery goes to one side
only.
• The pial branches forms
network surrounds the cord,
and sends fine radial branches
into the white matter of the
spinal cord tracts.

9. Spinal Cord Blood Supply
•Arteriolar sized vessels from both the anterior spinal & both posterior spinal arteries
encircle the spinal cord forming a fine pial plexus —> these vessels constitute the
vasocorona , from which short branches penetrate and supply the lateral parts of the
cord

10. POSTERIOR SPINAL ARTERY
- Paired artery
-Run along postero lateral cord dorsal to nerve roots
-discontinuous
-Originates either directly from vertebral or pica
-Has contribution from numerous 10-23 radicular
arteries.
-Supplies posterior one third.

11. Spinal Cord Blood Supply
Ventral Dorsal

12. RADICULAR ARTERY
The anterior and posterior arteries alone can only supply
enough blood to maintain the upper cervical segments of the
spinal cord hence they must be supplied with blood at
increasingly lower levels. This is accomplished via
radicular arteries
Various Radicular arteries supply the anterior & posterior
spinal arteries along the spinal canal:
Cervical Region:
1)vertebral arteries
2)posterior inferior cerebellar arteries
3)segmental branches from ascending cervical and deep
cervical a.

13. Thoracic & Lumbar region
• Intercostal and lumber arteries
• Sacral artery
· This region has only a few radicular arteries supplying
the cord vessels (ant & post spinal arteries), therefore reserve
blood supply is precarious.
Between C8 & T9 only two small radicular branches
supply this long segment of the cord.
There are a greater number on the posterior (10-23) than
anterior (6-10 only) side of the cord

15. •The distance between radicular arteries is greatest in the
thoracic spinal segments, thus occlusion of one thoracic
radicular artery may seriously compromise the circulation.
Therefore, the upper thoracic (T1-4) segment is particularly
vulnerable to ischemia after vascular occlusions called
watershed area.
•Usually few large segmental radiculospinal arteries are
noted, including the artery of Adamkiewicz (or artery of the
lumbar enlargement), which is larger than the others; it
usually originates between T9 and T12 (in 75% of cases),
mostly left side and supplies the lower two third of the cord.
The Great Radicular Artery (artery of Adamkiewicz)
• It is important because it is the major blood supply to the
inferior 2/3 of the spinal cord.

17. Anterior branch which joins anterior spinal artery –
Radiculomedullary artery
Arterial branch which joins posterior spinal artery –
Radiculopial arttery
Radiculopial arteries join the posterior spinal arteries and the
pial plexus, but do not provide major penetrating branches
into the spinal cord substance.
Radiculomedullary arteries join the anterior spinal artery and
send branches into the ventral sulcus and into the cord
substance.

20. SULCAL ARTERIES
-Originates from anterior spinal
axis
-Supply one half of the ant portion
of spinal cord.
-Branch at the level of gray matter
where they constitute the
centrifugal vascular system of
adamkiewicz
-Density of perforators is
proportional to the activity of
gray matter

21. RADIAL PERFORATING ARTERIES
-ORIGINATE FROM THE PIAL NETWORK OR VASA
CORONA.
-CONSTITUTE CENTRIPETAL SYSTEM OF ADAMKIEWICZ.
-PENETRATE WHITE MATTER,IN WHICH THEY DIVIDE INTO
AXIAL AND LONGITUDINAL BRANCHES.
-MAINLY SUPPLY THE WHITE MATTER.

22. Venous drainage of the spine can
be subdivided into an
Anterior external venous
plexus, located along the ventral
surface Of the vertebral body; the
anterior interior venous plexus,
Located in the epidural space
ventral to the thecal sac; the
Posterior internal venous
plexus, located in the epidural
space Dorsal to the thecal sac;
and the posterior external
venous
Plexus, located along the dorsal
surfaces of the laminae, facets,
And spinous processes.
VENOUS DRAINAGE

24. •Robust anastomoses connect the vertebral plexus with
multiple other venous elements, including the inferior vena
cava and segmental veins, the azygous system, the sacral and
pelvic plexi, the prostatic plexus, and the intracranial dural
sinuses.
•These spinal veins have no valves, and blood passes directly
into the systemic venous system. The continuity of this
venous plexus with the prostatic plexus is probably the path
along which prostatic neoplastic cells metastasize.

25. •Venous drainage of the spinal cord occurs via a radially
arranged system, which transmits venous blood from the
central portion of the cord into a pial venous plexus on the
cord’s surface.
•An anterior spinal vein and a posterior vein are located near
the midline of the ventral and dorsal surfaces of the spinal
cord, respectively.
•The pial plexus and anterior and posterior spinal veins drain
along radiculomedullary veins located in the dorsal or
ventral roots into epidural veins
•Although these radiculomedullary veins are valveless, there
are multiple functional obstructions to venous reflux from
the epidural system to the intradural system

27. APPLIED ANATOMY
Anterior cord Syndrome:
Also known as anterior spinal artery syndrome, or Beck’ s
syndrome
•Complete motor paralysis below level
•Loss of pain and temp.
•Intact posterior column sensation
•Autonomic dysfunction
•Bladder and bowel dysfunction

28. Posterior cord syndrome
•It is rare, occurs due to interruption of posterior spinal
artery
•Loss of proprioception + loss of vibration + two point
discrimination + loss of light touch

29. Occlusion of artery of Adamkiewicz
•Occurs during thoracoabdominal aortic surgery,
trauma, spine surgery
•Leads to paraplesia, loss of pain and temperature
sensation, loss of sphincter control

30. Spinal dural arteriovenous fistula
•Type 1 spinal arteriovenous malformation.
•Dural arteriovenous fistulae form between a dural artery and a
radicular or radiculomedullary vein, resulting in venous hypertension
in the pial plexus with secondary myelopathy.
•Thus, the lesion is usually intradural and represents a fistulization
between an extradural artery and an intradural vein.
• Because multiple dural arteries may participate in such a fistula,
treatment is usually directed at surgical or endovascular occlusion of
the final common pathway: the intradural radiculomedullary vein

31. THANK YOU