The Artery of Adamkiewicz: Anatomy and Considerations in Spine Surgery - A Review of the Literature.

The artery of Adamkiewicz (AKA) provides blood supply to the thoracolumbar spinal cord. Any disruption of the AKA can lead to the anterior spinal artery (ASA) syndrome, with devastating systematic and neurologic complications for the patient. This is a narrative review of the anatomy of AKA, the characteristics of ASA syndrome and the role of radiologic techniques in diagnosis and treatment. A detailed search of the PubMed database was conducted from January 2000 until April 2020, to locate articles relevant to our study. The references of the included studies were also retrieved in order not to miss any information. The ASA syndrome can present as a possible post-operative complication after minimally invasive or open surgeries of multiple specialties that involve the field of spine. Risk factors associated with ASA syndrome include; kyphosis of the patient, corresponding spinal surgical approach, intraoperative hypotension, multiple ligations of the AKA, a left side approach and a 360-combined or revision surgery. The incidence varies among different operations. Many different imaging modalities have been used in preoperative plan, including but not limited to computed tomography angiography, magnetic resonance angiography, and subtraction angiography. The use of computed tomography angiography or magnetic resonance angiography preoperatively can play a major role in the prevention of the ASA syndrome. However, more research needs to be done before making any final assumptions.

Anatomical Variation of a Communicating Branch between the Musculocutaneous and the Median Nerve: A Case Report.

OBJECTIVE: The aim of our paper is to depict an anatomical variation of the brachial plexus, concerning a communicating branch between the median and the musculocutaneous nerve and its clinical significance. Anatomical variations of the brachial plexus and especially those of the musculocutaneous nerve are quite common. Awareness of these variations is of paramount importance in clinical practice, mainly in achieving best results in minimal invasive or surgical procedures. CASE REPORT: After dissection in upper extremities in a 89-year-old male cadaver, a communicating branch between the median and the musculocutaneous nerve was found. This communicating branch was formed before the musculocutaneous nerve perforated the coracobrachialis muscle. It also derived from the level of the ansa medianis and its course was of an approximately 2cm length. CONCLUSION: The clinical significance of our study is the entrapment of the musculocutaneous nerve that may cause clinical findings similar to those of the carpal tunnel syndrome.