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Blood supply of the spinal cord
How blood reaches the cord: one anterior and two posterior spinal arteries running its length, topped up along the way by radiculomedullary arteries from the aorta, the largest being the artery of Adamkiewicz.
Updated 2026-10-023 sources
Why it matters
The front of the lower cord can depend heavily on a single feeding artery. Injury to the artery of Adamkiewicz, or failure to reconstruct it, during aortic surgery can cause neurological deficits from spinal cord ischaemia [1].
What it is
The cord is supplied by arteries that run along its length [2, 3]:
- Branches of the left and right vertebral arteries merge into the anterior spinal artery, which supplies the front of the cord and runs along the anterior median fissure [2].
- The paired posterior spinal arteries usually branch from the vertebral or posterior inferior cerebellar arteries and run along the posterolateral surface of the cord [3].
How it works
Arteries from above are not enough on their own. Segmental arteries from the aorta give rise to anterior and posterior radiculomedullary arteries, which feed the anterior and posterior spinal arteries [3]. The most dominant anterior radiculomedullary artery is the artery of Adamkiewicz, which supplies the cord from T8 to the conus medullaris [1].
The posterior spinal arteries, together with a pial arterial plexus fed by both the posterior and anterior spinal arteries, supply the posterior white columns, the back of the grey matter and the outer parts of the anterior and lateral columns [3]. The vertebral arteries are protected in the neck by the transverse foramina of the cervical vertebrae [2].
Normal behaviour
The artery of Adamkiewicz varies between people. In a meta-analysis it was present in 84.6 %[1] of people; most often there was a single one, on the left side, arising between T8 and L1 [1].
Pooled by level of origin, it arose most often at T9 (22.2 %[1]), T10 (21.7 %[1]) and T11 (18.7 %[1]) [1]. It continued from the aorta to the anterior spinal artery in 71.3 %[1] of patients in the studies that reported it [1].
When it does not behave
Infarction in the territory of a posterior spinal artery is rare; because of the artery's territory, it typically presents with posterior column dysfunction [3]. After loss of many intercostal and lumbar arteries, the remaining collateral supply can be marginal and the cord very vulnerable to low blood pressure [1].
Common misconceptions
Misconception: The spinal arteries carry enough blood down from the head for the whole cord.
Check yourself
Which artery runs along the anterior median fissure?
The anterior spinal artery, formed by branches of the two vertebral arteries [2].
Where does the artery of Adamkiewicz usually arise?
Most often a single artery on the left, between T8 and L1 [1].
Read next
- Artery of Adamkiewicz, with its variation chart.
- Posterior spinal arteries.
- Incomplete cord syndromes.
References
- Taterra D, Skinningsrud B, Pękala PA, Hsieh WC, Cirocchi R, Walocha JA, et al.. Artery of Adamkiewicz: a meta-analysis of anatomical characteristics. Neuroradiology. 2019;61(8):869-880. doi:10.1007/s00234-019-02207-y
- Betts JG, Young KA, Wise JA, Johnson E, Poe B, Kruse DH, et al.. 13.3 Circulation and the Central Nervous System. Anatomy and Physiology 2e. OpenStax. 2022. https://openstax.org/books/anatomy-and-physiology-2e/pages/13-3-circulation-and-the-central-nervous-system
- Iwamoto M, Fukunaga A, Uehara T. Posterior Spinal Artery Infarction With Unilateral Lumbar Spinal Cord Lesion: A Challenge in Early Diagnosis. Journal of General and Family Medicine. 2026;27(3). doi:10.1002/jgf2.70122
For learning only. This page does not diagnose, predict outcomes or recommend treatment. Corrections are welcome: how to suggest one.