Abstract
Thoracic endoscopic spine surgery is gaining traction. During thoracic
decompression, the arterial Adamkewicz system (AKA) can be encountered, with
potentially severe implications if injured. This chapter outlines a diagnostic protocol
and patient selection for the surgery based on a study examining surgical risks tied to
the radicular magna artery. The authors share insights from fifteen patients with
thoracic herniated discs and spinal stenosis who underwent preoperative CTA. This
assessed the anatomical relationship of the Magna radicular artery to the surgical area.
The Adamkiewicz artery's prevalent locations were T10/11 (15.4%), T11/12 (23.1%),
and T9/10 (30.8%). Patients were grouped into three categories based on their
pathology's proximity to the AKA foraminal entry. In five instances, the Magna
radicular artery entered the spinal canal near the nerve root at the surgery site,
prompting a surgical approach adjustment. The authors advocate for CTA evaluation to
gauge surgical risks and adapt thoracic discectomy techniques based on the magna
radicular artery's closeness to the pathology.