The vascular supply of the lumbar vertebral column is a diverse collection of arteries originating from both central and peripheral sites. Until recently, the majority of these studies have been dedicated to the blood supply of the spinal cord and vertebral bodies. More recent effort has been directed toward the identification of the vascular supply to the lumbar nerve roots. These studies have conclusively documented the presence of a dual blood supply to the nerve roots. In addition, this dual vascular supply has been discovered to have the capability for bi-directional flow. This unique property may allow for prevention of localized, compressive ischemic symptoms secondary to either herniated disc material or osteophytes. The nutrient contributions of the cerebrospinal fluid and venous supply to nerve roots have also been investigated. Early studies indicate that they may play a greater role than suspected. The presence of multiple sources of nutrient supply to the lumbar nerve roots enables them to be resistant to the potential compressive phenomenon that may occur in the lumbar spine.