Vascular supply to the lumbar spine: an intimate look at the lumbosacral nerve roots.

From Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania. *Dr. Gilchrist is a fellow, **Dr. Slipman is a director of the Penn Spine Center, associate professor, #Dr. Isaac is a fellow, ##Dr. Lenrow is assistant professor of the Department of Rehabilitation Medicine and ♦Dr. Chou is director of Physical Medicine & Rehabilitation Services at Penn Medicine at Radnor and assistant professor of the Department of Rehabilitation Medicine at Hospital of the University of Pennsylvania. Address correspondence: Curtis W. Slipman, MD, 3400 Spruce Street, Philadelphia, PA 19104. E-mail: slipman@mail.med.upenn.edu The vascular supply of the lumbar nerve roots provides a fascinating and complicated mechanism by which nutrition is delivered and breakdown products removed. Until recently, the emphasis of most anatomic vascular studies has been devoted to elucidating the supply of the spinal cord. In fact, it was not until the 19th century that the direct vascular supply of the spinal cord was correctly identified (1,2). Only loose associations were made about the lumbar nerve roots’ vascular supply at that time. Attention to the arterial supply of the nerve roots was first brought into the forefront by Verbiest et al (3) in 1954. His landmark article examined lumbar spinal stenosis as a cause for intermittent claudication of the lumbar nerve roots resulting in lower extremity pain symptoms. Since then, a number of anatomic studies have definitively identified the vascular supply of the lumbar nerve roots (4-8). This article will consolidate the anatomic knowledge gleaned to date involving the vascular supply of the lumbar nerve roots. A brief overview of the vascular supply to the lumbar spine will be presented to allow the reader a more comprehensive understanding of the complex nature of arterial and venous vascular patterns.