Oblique Transcorporeal Drilling to Treat Anterior Compression of the Spinal Cord at the Cervical Level

George, Bindu; Lot, Guillaume

doi:10.1055/s-2008-1053448

Cited by 25 publications

(11 citation statements)

References 3 publications

(3 reference statements)

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“…2, 3). George reported that the only morbidity directly related to this technique was Horner's syndrome, which cannot be avoided, in the immediate postoperative period [6]. However, controlling and displacing it medially have preserved the main sympathetic trunk.…”

Section: Discussionmentioning

confidence: 99%

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Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine

et al. 2008

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The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the cervical spine, resulting in Horner's syndrome. No quantitative regional anatomy in fresh human cadavers describing the course and location of the cervical sympathetic trunk (CST) and its relation to the longus colli muscle (LCM) is available in the literature. The aims of this study are to clearly delineate the surgical anatomy and the anatomical variations of CST with respect to the structures around it and to develop a safer surgical method that will diminish the potential risk of CST injury. In this study, 30 cadavers from the Department of Forensic Medicine were dissected to observe the surgical anatomy of the CST. The cadavers used in this study were fresh cadavers chosen at 12-24 h postmortem. The levels of superior and intermediate ganglions of cervical sympathetic chain were determined. The distance of the sympathetic trunk from the medial border of LCM at C6, the diameter of the CST at C6 and the length and width of the superior and intermediate (middle) cervical ganglion were measured. Cervical sympathetic chain is located posteromedial to carotid sheath and just anterior to the longus muscles. It extends longitudinally from the longus capitis to the longus colli over the muscles and under the prevertebral fascia. The average distance between the CST and medial border of the LCM at C6 is 11.6 ± 1.6 mm. The average diameter of the CST at C6 is 3.3 ± 0.6 mm. Superior ganglion of CSC in all dissections was located at the level of C4 vertebra. The length and width of the superior cervical ganglion were 12.5 ± 1.5 and 5.3 ± 0.6 mm, respectively. The location of the intermediate (middle) ganglion of CST showed some variations. The length and width of the middle cervical ganglion were 10.5 ± 1.3 and 6.3 ± 0.6 mm, respectively. The CST's are at high risk when the LC muscle is cut transversely, or when dissection of the prevertebral fascia is performed. Awareness of the CST's regional anatomy may help the surgeon to identify and preserve it during anterior cervical surgeries.

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Section: Discussionmentioning

confidence: 99%

“…Whatever the importance of the Horner's syndrome, it has no functional consequences but only creates slight cosmetic problems. The probability of occurrence of the Horner's syndrome was reported as 20% and it changes depending on the surgeon's experience [6].…”

Section: Discussionmentioning

confidence: 99%

Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine

et al. 2008

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“…However, their presence should be taken into account during lateral approaches to the cervical neuroforamen or during any lateral approach to the second seg-ment of the VA, particularly if dissection or transposition of the artery is anticipated. 3,10,12…”

Section: Discussionmentioning

confidence: 99%

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

Paolini

Lanzino

2006

SPI

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Object During surgical procedures focused on the cervical nerve roots, the surgeon works in proximity to the V2 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 V2 segment during anterior and anterolateral approaches to the cervical spine, the authors analyzed the relationship between the V2 segment and the proximal segment of the C3–6 nerve roots. Methods Six cadaveric cervical spines (12 sides) were fixed with formalin, injected with red and blue latex, and investigated intraoperatively using different magnifications (× 3–40). 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. Conclusions Proximal-to-distal dissection of a cervical nerve root may proceed with relative safety for at least 4 mm. The V2 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.

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“…In that case, the VA runs in the middle of the longus colli muscle at C6, which can be severed inadvertently when the C6-7 disc is surgically treated. 30,31,36 Surgeons must be very careful while working in close proximity to the VA. In our series there was no case of VA injury.…”

Section: Anterior Cervical Microforaminotomymentioning

confidence: 99%

Prospective study of anterior cervical microforaminotomy for cervical radiculopathy

Kotıl

Bılge

2008

Journal of Clinical Neuroscience

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Oblique Transcorporeal Drilling to Treat Anterior Compression of the Spinal Cord at the Cervical Level

Cited by 25 publications

References 3 publications

Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine

Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine

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

Prospective study of anterior cervical microforaminotomy for cervical radiculopathy

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