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Spinal cord: Blood supply

The spinal cord is perfused via spinal arteries which arise from branches of larger vessels including vertebral, intercostal, and lumbar arteries. Blood flow to the cord is directly supplied by 1 anterior and 2 posterior arteries. The anterior spinal artery, which courses caudally in the anterior sulcus of the spinal cord, is formed by the union of vertebral arteries. It is responsible for 75% of the spinal cord’s blood supply. Numerous radicular branches join the anterior spinal artery as it descends. The arteria medullaris magna anterior (Artery of Adamkiewicz) is the main source of arterial blood for the lower 2/3 of the spinal cord and the most important radicular artery. Most commonly the Artery of Adamkiewicz originates between T9 and T12, followed by L1 to L5, and least commonly it originates between T5 and T8.

The remaining 25% of spinal cord blood supply comes from the 2 posterior spinal arteries. These are formed from the vertebral or posterior inferior cerebellar arteries. The posterior arteries supply the posterior 1/3 of the spinal cord.