Anterolateral approach to the cervical spine: major anatomical structures and landmarks

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The study was conducted in 30 fresh cadavers.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The common carotid artery bifurcation was mostly found at the level of C-4 (78%). The inferior belly of the omohyoid muscle was seen to cross the sternocleidomastoid muscle at the C5–6 disc level along the entire C-6 vertebral body. To reach the lower cervical region, the sacrifice of this muscle makes the procedure easier. The facial vein drained into the internal jugular vein mostly at the level of C3–4 (54%). The superior ganglion of the cervical sympathetic chain was located at the C-4 vertebra, but the location of the intermediate ganglion exhibited some variation. The vertebral artery entered the transverse foramen of C-6 in 27 cadavers (90%), the transverse foramen of C-7 in two cadavers (7%), and the transverse foramen of C-4 in one cadaver (3%). Because the inferior thyroid artery crossed the C6–7 interspace obliquely, the course of the inferior thyroid artery may complicate the procedure. The C-5 uncinate process was shortest and narrowest and had the greatest distance from the medial edge of the process to the anterior tubercle (p &lt; 0.001).</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Understanding the qualitative anatomy of this region not only improves the safety of anterior and anterolateral cervical spine surgery but also allows adequate decompression of neural elements and resolution of the other pathological processes of this region. In this fresh cadaveric study, our goal was to improve the approach and decrease the incidence of complications.</jats:p></jats:sec>

Computed tomographic evaluation of the distance between the medial border of longus colli muscle and foramen transversarium in ventral approaches to the subaxial cervical spine.

“…Injury to the V 2 segment of the VA may occur during lateral dissection of the vertebral body (VB) with subperiosteal elevation of the longus colli muscles or lateral drilling of the uncinate process (18). The longus colli muscle is the longest and most medially located of the prevertebral muscles (4), located on the anterior aspect of the cervical spine and divided into a superior oblique, inferior oblique, and vertical parts (11). Reflecting or removing the longus capitis and longus colli muscles exposes the transverse process and vertebral artery (11).…”

Quantitative evaluation of the anatomical parameters for subaxial cervical spondylectomy: an anatomical study

“…The distance between musculi longus colli on both sides widens as it descends. Civelek et al 2 determined that the origin of the musculus longus capitis is the tuberculum anterius of the C3-6 in 57% and of the C3-7 in 43% of specimens. The musculus longus capitis can be retracted laterally over the musculus longus colli.…”

“…Civelek et al 2 showed that 90% of the arteria vertebralis enters the foramen transversarium at the C-6 level, 7% enter at the C-5 level, and 3% enter at the C-4 level. This information should be considered before performing operations requiring wide anterolateral resection, such as a spondylectomy.…”

Neck muscle function in individuals with persistent pain and disability after whiplash injury

“…The C4 level was verified with a transverse ultrasound projection of the bifurcation of the carotid artery at the right ventral side of the neck. The carotid artery is commonly observed at the C4 level (91). The transducer was then rotated to a longitudinal position and the ventral images were recorded in this position (Fig.…”

“…However, the C4 spinous process and vertebral column were used as reference points in the dorsal images and the bifurcation of the carotid artery (commonly at the C4 level) (91), in the ventral images. Another potential limitation was that the ROI was selected manually for each muscle.…”