Surgical Anatomy of the Nuchal Muscles in the Posterior Cervicothoracic Junction

Ono, Atsushi; Tonosaki, Yoshikazu; Yokoyama, T.; Aburakawa, Shuichi; Takeuchi, Kazunari; Numasawa, Takuya; Wada, Kanichiro; Kachi, Takashi; Toh, Satoshi

doi:10.1097/brs.0b013e31817152cc

Cited by 28 publications

(9 citation statements)

References 14 publications

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“…The accuracy in identifying C7 using manual palpation by clinicians is limited due to the inter-individual variation in the morphology of C7-SP ( 15 – 19 ). While several studies have assessed the anatomic structures of C7-SP, most of them focus on the mechanisms of diseases affecting it ( 8 , 20 , 21 ). The SP extends from the posterior of the vertebral arch to provide connection points for the muscles that extend from the neck, including the trapezius and spinalis muscles.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, C7-SP is used as a point of reference for determining the level to insert epidural catheters by anesthesiologists, and a C7-T1 level of entry is recommended for cervical interlaminar epidural steroid injection ( 7 ). In addition, owing to the complex attachment of nuchal muscles to the spinous process, the SP should be preserved to reduce the incidence of postoperative axial pain ( 8 ). For the most part, decisions regarding surgical treatment made by the physician are affected by the anatomic characteristics of C7-SP.…”

Section: Introductionmentioning

confidence: 99%

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An anatomical study of the spinous process of the seventh cervical vertebrae based on the three‑dimensional computed tomography reconstruction

et al. 2018

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Palpation of the seventh cervical vertebra (C7) is important for the diagnosis and treatment of neck and chest conditions. However, the spinous process of C7 (C7-SP) displays an anatomical deviation among individuals. The present study aimed to clarify anatomic characteristics of C7-SP by using a three-dimensional (3D) computed tomographic (CT) reconstruction technique. A total of 245 subjects meeting the selection criteria were examined. After CT scanning, the images were reconstructed in 3D. All subjects were grouped according to their deviation of C7-SP: Deviating to the right (DR group), deviating to the left (DL group) and no deviation (ND group). Three distances and three angles were recorded on C7-SP. The vertical distances between the borders of the left and right transverse processes and the tip of the SP, were termed DLTS and DRTS, respectively. The length of the SP was also determined. The angle of the SP deviation was referred to as ∠α, the angle between the SP axis and the line crossing the tips of the transverse processes was referred to as ∠β and the angle between the vertebral body axis and the SP axis was referred to as ∠γ. Among the three groups, differences in ∠α and ∠β were statistically significant (P<0.05). Furthermore, the DLTS was significantly different between the DL and ND groups (P<0.05). In addition, a significant difference in the DRTS was identified between the DR and ND groups (P<0.05). 3D CT reconstruction was reliable for studying anatomic characteristics of C7-SP. Based on this, patients may be preliminarily grouped according to the deviation of their C7-SP and the measurement of the C7-SP may guide clinical diagnoses and treatments.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

An anatomical study of the spinous process of the seventh cervical vertebrae based on the three‑dimensional computed tomography reconstruction

et al. 2018

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“…These findings suggest that preserving the C7 spinous process is extremely important. An anatomic study [29] reported that in the C3–C6 procedure, the rhomboideus minor in 35%, the serratus posterior superior in 100%, and the splenius capitis in 67% were partly preserved at the C7 spinous process; the rhomboideus major in 76% and splenius cervicis in 80% were completely preserved without partial dissection of their attachment. Otherwise, in the C3–C7 laminoplasty, the possibility of partial preservation of the rhomboideus minor, serratus posterior superior, and splenius capitis at the C7 spinous process was 0%, 66%, and 29%, respectively; the rhomboideus major in 16% and the splenius cervicis in 56% could be completely preserved.…”

Section: Discussionmentioning

confidence: 99%

Preserving the C7 spinous process in laminectomy combined with lateral mass screw to prevent axial symptom

Zhang

Shen

Zhang

et al. 2011

Journal of Orthopaedic Science

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BackgroundPreserving the C7 spinous process during cervical laminoplasty has been reported to prevent axial symptom. Some patients underwent laminectomy and fixation developed the symptom. The objective of this article was to investigate whether axial symptom can be reduced by preserving the C7 spinous process during cervical laminectomy and fixation with lateral mass screw.MethodsBetween 2005 and 2008, data of 53 patients who underwent laminectomy and lateral mass-screw fixation for multilevel cervical myelopathy were reviewed. Analysis consisted of the incidence of axial symptom, Japan Orthopaedic Association (JOA) scores, recovery rate, cervical lordotic angle, and atrophy rate of cervical posterior muscle. Axial symptom severity was quantified by a visual analog scale (VAS). Twenty-five patients were decompressed from C3 to C7 (group A) and 28 from C3 to C6 with dome-shape removal of the C7 superior lamina (group B) .ResultsAnalysis of final follow-up data showed improvement in clinical outcome for both groups. No difference in recovery rate, cervical lordotic angle and atrophy rate was observed between groups. Postoperative axial-neck pain was significantly rarer in group B than in group A. Axial symptom severity was correlated with cervical posterior muscle atrophy rate; correlation coefficient was 0.665.ConclusionThe C7 spinous process might play an important role in preventing axial symptom, but there is a need for randomized, control studies with long-term follow-up to clarify the results.

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“…Other authors have recommended not doing a C7 laminoplasty to preserve the muscular attachments to the spinous process of C7. 12 13 14 15 16 …”

Section: Introductionmentioning

confidence: 99%

Neck Pain following Laminoplasty

Mesfin

Park

Piyaskulkaew

et al. 2014

Global Spine Journal

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Study Design Retrospective evaluation of prospectively collected data. Objective To compare preoperative and postoperative neck pain following laminoplasty using the Neck Disability Index (NDI). Methods Seventy-two patients undergoing laminoplasty from 2006 to 2009 at a single institution were identified. Thirty-four patients with a minimum 1-year follow-up who completed preoperative, 6-week, and 1-year postoperative NDI questionnaires were enrolled. Demographic data and surgical data including estimated blood loss (EBL), length of surgery, number of laminoplasty levels, complications, and length of hospitalization were collected. Results Mean age was 62 years (range: 34 to 88), mean follow-up was 17 months (range: 12 to 31), and there were 21 men and 13 women. Diagnoses were cervical spondylotic myelopathy (n = 26), ossification of the posterior longitudinal ligament (n = 6), and central cord syndrome (n = 2). Mean EBL was 120 mL (range: 50 to 200), and mean surgical time was 152 minutes (range: 70 to 240). Average number of laminoplasty levels was 3 (range: 1 to 5). The open door technique was used, and 24/34 (71%) did not have laminoplasty at C3 and C7. No intraoperative complications were noted, and average hospital stay was 1.6 days (range: 1 to 7). Significant improvement in NDI total score was noted at 1 year (p < 0.002) and in NDI pain score at 6 weeks (p < 0.028) and 1 year (p < 0.007) postoperatively. Conclusions Patients having laminoplasty experienced significant improvement in NDI pain subscore and NDI total scores at a minimum of 1 year postoperatively.

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Surgical Anatomy of the Nuchal Muscles in the Posterior Cervicothoracic Junction

Abstract: The current study confirmed that C3-C6 laminoplasty in which the C7 spinous process is preserved reduces invasion of the nuchal muscles.

Cited by 28 publications

References 14 publications

An anatomical study of the spinous process of the seventh cervical vertebrae based on the three‑dimensional computed tomography reconstruction

An anatomical study of the spinous process of the seventh cervical vertebrae based on the three‑dimensional computed tomography reconstruction

Preserving the C7 spinous process in laminectomy combined with lateral mass screw to prevent axial symptom

Neck Pain following Laminoplasty

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