Spinal Cord Infarction Occurring during Thoraco-lumbar Sympathectomy.

The arterial blood supply of the spinal cord depends on a single anterior spinal artery and two posterior spinal arteries. The anterior spinal artery, which is the more important, commences within the cranial cavity by the union of the anterior spinal branches of each vertebral artery and subsequently is fed by several tributary arteries. Down the length of the spinal cord the anterior spinal artery receives paired tributaries accompanying each anterior nerve root, and, arising from the vertebrals, the ascending cervical branches of the inferior thyroid, the costocervical trunk, the costal, lumbar, iliolumbar, and lateral sacral arteries. Most of these arterial tributaries are small and the blood supply is largely dependent on four to 10 of these arterial tributaries which are especially large. Their position and size are variable, but at least one joins the cervical cord, two the thoracic cord, and one the lumbar cord. The largest thoracic tributary has been given the name, the great ventral radicular artery. Spinal cord infarction, because of interference with an important radicular tributary, is a rare complication of thoraco-lumbar sympathectomy. In a brief survey of the literature we found only 12 previously recorded cases in which this complication was presumed to have occurred. Rubio (1953, quoted by Corbin, 1961) reported three cases, and a further case was added by Mosberg, Voris, and Duffy (1954) who also cited four cases of Bassett (1948) and a personal communication of three cases of Poppen. Nathan (1956) mentions a further case. Detailed pathological observations at necropsy were made in two cases, that of Mosberg and that of Nathan. The following case report with necropsy findings describes spinal cord infarction occurring as a complication of the operation of thoracolumbar sympathectomy.