Anatomical relationships between the V2 segment of the vertebral artery and the cervical nerve roots

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>During surgical procedures focused on the cervical nerve roots, the surgeon works in proximity to the V<jats:sub>2</jats:sub> segment of the vertebral artery (VA). Depending on the specific surgical approach, it may be necessary to identify, expose, or mobilize the artery. In most cases, the artery may be left undisturbed. To reduce the risk of iatrogenic injury to the V<jats:sub>2</jats:sub> segment during anterior and anterolateral approaches to the cervical spine, the authors analyzed the relationship between the V<jats:sub>2</jats:sub> segment and the proximal segment of the C3–6 nerve roots.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>Six cadaveric cervical spines (12 sides) were fixed with formalin, injected with red and blue latex, and investigated intraoperatively using different magnifications (× 3–40).</jats:p> <jats:p>The VA rested on the anteromedial surface of the cervical nerve roots at the level of each intertransverse space. The exiting nerve roots intersected the VA at a distance ranging from 4.5 to 8.1 mm (mean 6.3 ± 1.06 mm) from the dural sac. The distance was slightly shorter at cephalad levels, suggesting that the artery is more posteriorly and medially situated at those levels. Arterial pedicles anchored the VA to the cervical nerve roots at various levels. These arteries gave rise to purely radicular, ligamentous, and medullary branches without a predictable pattern. After reaching the nerve roots on their lower margin, the nonligamentous branches pierced the radicular dural sheath within the neural foramen at a distance of 2 to 4 mm from the VA.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Proximal-to-distal dissection of a cervical nerve root may proceed with relative safety for at least 4 mm. The V<jats:sub>2</jats:sub> segment of the VA gives rise to at least one radicular arterial pedicle between C-4 and C-6. These trunks give rise to purely radicular, ligamentous, and medullary branches in an unpredictable pattern.</jats:p></jats:sec>

The cervical arteries: an anatomical study with application to avoiding nerve root and spinal cord blood supply

“…The anterolateral approach is used for transforaminal cervical discectomies and oblique cervical corpectomy (7,12,(16)(17)(18)(19)26). Additionally, transforaminal injections of corticosteroids have been popularized for treating cervical radiculopathy (2,13,21).…”

Quantitative Evaluation of the Location of the Vertebral Artery in Relation to the Transverse Foramen in the Lower Cervical Spine

“…[11][12][13] Posterior stabilization of the lower cervical spine is most frequently performed by lateral mass screws and transpedicular screw fixation, which has been introduced to provide a one-stage stable posterior fixation. One of complications of these techniques is vertebral artery injury.…”

The vertebral artery and the cervical pedicle: morphometric analysis of a critical neighborhood

“…31 The cervical nerve roots are located immediately above and below the pedicle, with almost no distance detected between the superior part of the pedicle and the nerve root, and with a space between the inferior wall and the next nerve root of only approximately 1.1-1.7 mm. 15,39,42 The dural sac is also close to the pedicles, located medially at a distance of approximately 2.4-3.1 mm to the pedicle wall.…”