A review of the embryology and anatomy of the blood supply to the spinal cord is presented. The main artery supplying the anterior cord is the great radicular artery (often referred to by the eponym "the artery of Adamkiewicz"). This artery usually originates from the left side of the aorta, most frequently between the ninth thoracic and first lumbar levels to supply blood to the anterior spinal artery However, variations in the origin of the artery are common. Blood supply to the spinal cord can be compromised during descending thoracic or thoracoabdominal aortic reconstructions, performed for aneurysmal disease or for aortic dissection. This may lead to devastating neurological complications, most notably paraplegia. Although the etiology of paraplegia is multifactorial, a relatively small artery plays an important role in the development of serious neurological complications.
