Spinal angiology

In this article we have limited ourselves to only some fundamental information on the problem of spinal angiology. The issues of blood supply to the spine and spinal cord, as well as the pathology associated with them, are quite fully reflected in the anatomical and neurological literature, published in Russian as well. We will only point out that the fundamental, domestic works are the works of D.K. Bogorodinsky and A.A. Skoromets et al. (1965-1998), and the foreign ones are G. Lazorthes et al. (1973) and WH Hollinshead (1982). We have borrowed almost all the data presented below from these works.

The segmental arteries, the branches of which supply the thoracic and lumbar sections of the spinal cord and vertebrae, originate directly from the thoracic and abdominal aorta. In the cervical region, the segmental arteries originate from the vertebral arteries. After the dorsal artery divides into the posterior musculocutaneous and spinal arteries, the latter enter the spinal canal together with the spinal rootlet. The section of the artery accompanying the spinal rootlet is called the radicular artery. Some of the arteries that enter the spinal canal terminate in the membranes of the spinal cord with their terminal branches (radiculomeningeal arteries), and only one out of every four or five radicular arteries directly reaches the spinal cord (radiculomedullary arteries). It should be noted that in the thoracic region, the number of radiculomedullary arteries is the smallest in comparison with other sections of the spinal cord.

Depending on the number of arteries reaching the spinal cord tissue, K. Jellinger (1966) identified two types of main spinal blood flow - pau segmental ("poor segmental") and plurisegmental. In the first case, the blood supply to the spinal cord is provided by two or three radiculomedullary arteries, in the second, their number is 5.6 or more.

Knowledge of the anatomical features of blood flow both along the length and across the spinal cord allows us to quite accurately determine 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 for the precise topographic determination of the area of vascular disorders of the spinal cord, accompanied by pathological clinical symptoms.

Summary data on spinal arterial pools

Authors	Arterial pools of the spinal cord
Zulch KJ (1954), Lazorthes G. et al. (1957), Corbin J.L. (1961)	The upper, intermediate and lower pools correspond to the basic diagram of arterial blood flow.
Bogorodinsky D.K., Skoromets A.A. et al. (1964, 1966, 1975), Jelling» K. (1966)	The superior subclavian-cervicovertebral basin (oral basin according to K. Jellinger) consists of the vertebral and other proximal branches of the subclavian arteries (aa. cervicalis, ascendens et profunda, intercostalis suprema), and provides blood supply to all cranial segments up to D2.
Maliszewski M. (1994)	The lower aortic basin (caudal basin according to K. Jellinger) is formed by aa. intercostales, subcostalis, lumbales, lumbales ima, iliosacrales, sacrales laterales et media; it provides blood supply to all spinal segments below D2. Upper cervical zone - C1-C3; mid-cervical zone - C4-C5; cervical enlargement - C5-C7; upper thoracic zone - D1-D3; mid-thoracic zone - D4-D12; thoracolumbar enlargement - D8-L5, lumbosacral zone - L5-Co.

Anatomical variants of the lower arterial basin (according to A.A. Skoromets et al., 1998)

Anatomical variant	Features of the variant	Frequency of occurrence
I	With one large radiculomedullary artery of Adamkiewicz	20.8%
II	With the artery of Adamkiewicz and the inferior accessory radiculomedullary artery (follows the lower lumbar or 1 sacral root and corresponds to the artery of Deproge-Gotteron)	16.7%
III	With the artery of Adamkiewicz and the superior accessory radiculomedullary artery (follows with one of the roots from T3 to T6)	15.2%
IV	Scattered type (plurisegmental type according to K.Jelliger) - the brain is supplied with nutrition by three or more radiculomedullary 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 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 the manifestations of vascular pathology in spinal cord injury, to which V.P. Bersnev et al. (1998) draw attention:

• discrepancy between the upper level of spinal cord disorders and the level of spinal injury. As a rule, pathological neurological symptoms are detected in areas innervated by spinal segments located above the level of the injured vertebral segments. F. Denis calls this pathology ascending traumatic myelopathy - myelopathy ascendens;
• the prevalence of anterior corneal (motor) disorders along the spinal cord - fasciculations and fibrillations, amyotrophy, atony, areflexia, as well as the identification of the indicated signs in areas corresponding to a specific vascular basin;
• rapidly transient recurrent motor disturbances, the presence of which is characteristic of transient compression of the main vessels of the spinal cord.

[ 1 ], [ 2 ], [ 3 ], [ 4 ], [ 5 ], [ 6 ]