{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,11]],"date-time":"2026-05-11T22:43:15Z","timestamp":1778539395181,"version":"3.51.4"},"reference-count":45,"publisher":"MDPI AG","issue":"2","license":[{"start":{"date-parts":[[2023,2,17]],"date-time":"2023-02-17T00:00:00Z","timestamp":1676592000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JPM"],"abstract":"<jats:p>Background: Casually cauterizing the radicular magna during routine thoracic discectomy may have dire consequences. Methods: We performed a retrospective observational cohort study on patients scheduled for decompression of symptomatic thoracic herniated discs and spinal stenosis who underwent a preoperative computed tomography angiography (CTA) to assess the surgical risks by anatomically defining the foraminal entry level of the magna radicularis artery into the thoracic spinal cord and its relationship to the surgical level. Results: Fifteen patients aged 58.53 \u00b1 19.57, ranging from 31 to 89 years, with an average follow-up of 30.13 \u00b1 13.42 months, were enrolled in this observational cohort study. The mean preoperative VAS for axial back pain was VAS of 8.53 \u00b1 2.06 and reduced to a postoperative VAS of 1.60 \u00b1 0.92 (p &lt; 0.0001) at the final follow-up. The Adamkiewicz was most frequently found at T10\/11 (15.4%), T11\/12 (23.1%), and T9\/10 (30.8%). There were eight patients where the painful pathology was found far from the AKA foraminal entry-level (type 1), three patients with near location (type 2), and another four patients needing decompression at the foraminal (type 3) entry-level. In five of the fifteen patients, the magna radicularis entered the spinal canal on the ventral surface of the exiting nerve root through the neuroforamen at the surgical level requiring a change of surgical strategy to prevent injury to this important contributor to the spinal cord\u2019s blood supply. Conclusions: The authors recommend stratifying patients according to the proximity of the magna radicularis artery to the compressive pathology with CTA to assess the surgical risk with targeted thoracic discectomy methods.<\/jats:p>","DOI":"10.3390\/jpm13020356","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T03:29:06Z","timestamp":1676863746000},"page":"356","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Identification of the Magna Radicular Artery Entry Foramen and Adamkiewicz System: Patient Selection for Open versus Full-Endoscopic Thoracic Spinal Decompression Surgery"],"prefix":"10.3390","volume":"13","author":[{"given":"Roth Antonio","family":"Vargas","sequence":"first","affiliation":[{"name":"RIWO Spine Center of Excellence, Department of Neurosurgery, Foundation Hospital Centro M\u00e9dico Campinas, Campinas 13083-210, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eduardo Miquelino","family":"De Olinveira","sequence":"additional","affiliation":[{"name":"Proton Diagn\u00f3sticos Hospital Centro, Campinas 13083-190, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marco","family":"Moscatelli","sequence":"additional","affiliation":[{"name":"Clinica NeuroLife, Natal 59020-300, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge Felipe","family":"Ram\u00edrez Le\u00f3n","sequence":"additional","affiliation":[{"name":"Minimally Invasive Spine Center, Reina Sof\u00eda Clini Department of Orthopaedics, Fundaci\u00f3n Universitaria Sanitas, Bogot\u00e1 111321, Colombia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Morgan P.","family":"Lorio","sequence":"additional","affiliation":[{"name":"Advanced Orthopedics, Altamonte Springs, FL 32701, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rossano Kepler","family":"Fiorelli","sequence":"additional","affiliation":[{"name":"Department of General and Specialized Surgery, Gaffr\u00e9e e Guinle University Hospital, Federal University of the State of Rio de Janeiro (UNIRIO), Rio de Janeiro 22290-250, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Albert E.","family":"Telfeian","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI 02903, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ernest","family":"Braxton","sequence":"additional","affiliation":[{"name":"Vail Summit Orthopaedics & Neurosurgery, Frisco, CO 80443, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Song","sequence":"additional","affiliation":[{"name":"Advanced Neurosurgery, Reno, NV 89521, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7842-2914","authenticated-orcid":false,"given":"Kai-Uwe","family":"Lewandrowski","sequence":"additional","affiliation":[{"name":"Center for Advanced Spine Care of Southern Arizona, Tucson, AZ 85712, USA"},{"name":"Department of Orthopaedics, Fundaci\u00f3n Universitaria Sanitas, Bogot\u00e1 111321, Colombia"},{"name":"Department of Orthopedics, Hospital Universit\u00e1rio Gaffre e Guinle, Universidade Federal do Estado do Rio de Janeiro, Rio de Janeiro 21941-901, Brazil"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,2,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"153","DOI":"10.1007\/s00586-019-06171-2","article-title":"Worldwide research productivity in the field of full-endoscopic spine surgery: A bibliometric study","volume":"29","author":"Lin","year":"2020","journal-title":"Eur. 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