The effects of lumbar sympathectomy on regional spinal cord blood flow in rats during acute hemorrhagic hypotension

Blood supply and vascular reactivity of the spinal cord under normal and pathological conditions

The authors present a review of spinal cord blood supply, discussing the anatomy of the vascular system and physiological aspects of blood flow regulation in normal and injured spinal cords. Unique anatomical functional properties of vessels and blood supply determine the susceptibility of the spinal cord to damage, especially ischemia. Spinal cord injury (SCI), for example, complicating thoracoabdominal aortic aneurysm repair is associated with ischemic trauma. The rate of this devastating complication has been decreased significantly by instituting physiological methods of protection. Traumatic SCI causes complex changes in spinal cord blood flow, which are closely related to the severity of injury. Manipulating physiological parameters such as mean arterial blood pressure and intrathecal pressure may be beneficial for patients with an SCI. Studying the physiopathological processes of the spinal cord under vascular compromise remains challenging because of its central role in almost all of the body's hemodynamic and neurofunctional processes.

Arteriovenous glomeruli of the human spinal cord and their possible functional implications

A previous investigation of the radiculomedullary vascular distribution of the human spinal cord showed an immediate filling of the peripheral spinal veins during arterial injections. Because the perfused medium, a mixture of latex and India ink, had a sufficient viscosity to preclude capillary passage, an extensive system of arteriovenous anastomoses (AVA) was indicated. The injection of five additional anatomic cadaver spinal cords was undertaken to specifically determine the intraparenchymal position and structure of these AVA. It was found that only cleared and transilluminated longitudinal parasagittal sections adequately showed that the AVA were formed by an extensive array of intricately coiled arteriovenous glomeruli (AVG) that could pass substantial amounts of blood from third order arterial branches to equivalently sized veins, bypassing the capillary bed. The epithelioid structure of these AVG channel walls, coupled with their highly innervated adventitial tissue indicated a possible functional relationship to similar structures found in the ends (digital pads) of mammalian extremities. Stained serial sections of injected cords showed the vascular relations with nerve fibers derived from the intraspinal parenchyma as well as a possible extraparenchymal autonomic fiber source. The numbers and extent of these AVG complexes suggested they might be involved in the remarkable autoregulation of spinal cord blood flow (SCBF) that is impervious to middle range changes in systemic blood pressure. Future research may more accurately determine the functional role of these previously unreported human spinal AVG, particularly in their possible relation to SCBF autoregulation in normal and injured spines.