IMPORTANCE OF THE ADAMKIEWICA ARTERY IN SPINAL TUMOURS

To identify the presence of the Adamkiewica artery before operating spine tumor patients and avoid neurological complications as well as evaluate the impact on surgical strategy. All tumor patients requiring spinal fixation from Feb 2002 to March 2006 were prospectively enrolled in the study. Included patients either had a primary spine tumor or a spine metastasis. Patients underwent a selective arteriography of the level above, the level below and the level involved by the tumor in order to document any Adamkiewicz artery (AKA). Eighteen patients were enrolled. Six had a primary tumor and twelve had a metastasis between levels T1 to L3. There were no complications related to the radiological procedure. For ten (55%) of patients, the AKA was identified during the selective arteriogram. In seven of the twelve (58%) metastatic cases the AKA was found adjacent to the involved level. In 60% of cases the AKA was found on the left side. In all cases where the AKA was found, the surgical strategy was modified in order to preserve the AKA. No patients had permanent neurological complications. The location of the AKA is extremely variable. in more than half our cases, the AKA was found immediately adjacent to the involved level. This could suggest a vascular explanation for the location of tumors in the spine. The vicinity of the AKA to the tumor site may explain why neurological complications are frequent when operating such spine cases.