The blood supply to the spinal cord is from a single anterior spinal artery and two posterior spinal arteries. These arteries are fed via segmental spinal arteries at every vertebral level. There are a number of reinforcing arteries (segmental medullary arteries) along the length of the spinal cord—the largest of which is the artery of Adamkiewicz. This artery of Adamkiewicz, a segmental medullary artery, typically arises from the lower thoracic or upper lumbar region, and unfortunately during this patient’s aortic dissection, the origin of this vessel was disrupted. This produces acute spinal cord ischemia and has produced the paraplegia in the patient.