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Judicious use of implants and careful preoperative planning to determine optimal implant sizes are paramount. Spinal cord infarction due to interruption of the spinal vascular supply during anterior thoracolumbar surgery is a rare but devastating complication. Here, the authors sought to summarize the data on this complication in terms of its incidence, risk factors, and operative considerations. They also sought to summarize the relevant spinal vascular anatomy. They performed a systematic literature review of the PubMed, Scopus, and E