ANATOMY OF THE SPINAL CORD’S BLOOD SUPPLY. Review
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Keywords

spinal cord vascularization, cervical region, radiculo-medullary arteries

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Chernyak , V., Shevchenko, O., Zorenko, O., Levon, M., Selivanov , S., & Holinko V.M., V. (2020). ANATOMY OF THE SPINAL CORD’S BLOOD SUPPLY. Review. Medical Science of Ukraine (MSU), 16(2), 59-68. https://doi.org/10.32345/2664-4738.2.2020.11

Abstract

Relevance. The traditional scheme of blood supply to the spinal cord, formed in the 60-70s of the last century, does not correspond to the pathogenesis of many neurological disorders of the spinal cord. There is also a discrepancy in terminology: the names of arteries found in surgical and neurological works do not correspond to the names of the International Anatomical Nomenclature. Therefore, today this issue needs further analysis.

Objective: to summarize the information of different authors on the number of spinal branches and their branches, topography, blood supply to each segment of the spinal cord, to analyze the individual variability of sources of blood supply to the spinal cord.

Materials and methods. Analysis of scientific publications in the international electronic scientometric database PubMed by keywords for the period 2000-2018. and comparing these data with the imaginations of 1760-1993.

Results. The idea of ​​the structural organization of the blood supply to the spinal cord has changed. With modern data, intracranial sources, namely: anterior and posterior spinal arteries, the blood supply to the true cervical spinal cord, and the rest of the department - lower cervical, thoracic, lumbar, sacral and coccygeal - blood supply from extracranial sources, and they exist in this area segmental branches of the aorta. Nowadays, extracranial sources are considered the main in the blood supply to the spinal cord. It is now known that the anterior and posterior spinal arteries are intermittent and cannot provide blood supply to the spinal cord, as previously thought. The general plan of arterial blood supply of a spinal cord can be presented in the form of a set of pools of front and back radical (radiculomedullary) arteries. The anterior radicular arteries are 4-8, and the posterior 15-20, respectively, along the spinal cord in its ventral and dorsal departments the same number of arterial pools are formed. There are anastomotic connections between these pools, which are not always functionally complete. Each of these basins is supplied by a separate radiculomedullary artery. Each such artery feeds not one but several segments of the spinal cord. The number and levels of approach to the spinal cord of radiculomedullary arteries, especially the anterior ones, differ significantly in individual variability. The perception of the vascularization of the cervical spinal cord was analyzed. At different times, information about the number of arteries that supplied blood to this department differed significantly: in 1760 it was believed that it was 31 arteries; and in 1882-1939 - only 7; in 1943 - 27, in 1958 - 6-8; in 1958 - 7-10; in 1961-1963 - 5-8; in 1966-1973 - 5; in 1993 - 1-2 arteries. Such different information about spinal cord vascularization is the result of significant individual variability.

Conclusions. Incomplete current knowledge about the blood supply to the spinal cord is the cause of unresolved problems of etiology, pathogenesis, and clinical course of spinal ischemic strokes, including cervical localization. The existing terminological confusion regarding the names of the arteries that supply blood to the spinal cord, in particular its cervical region, is explained by the significant variability of the radiculomedullary arteries of this zone in terms of number, diameter, and location. Due to the existence of arterio-venous anastomoses, arterial myelobulbar anastomoses, adjacent areas of blood supply in this area, theft phenomena are formed and distant foci of ischemia appear, including both the spinal cord and the brain. Therefore, in order to make an angiotopic diagnosis, it is necessary to take into account not only anatomical but also physiological and pathophysiological aspects of regulation and compensation of cerebral circulation.

https://doi.org/10.32345/2664-4738.2.2020.11
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