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

Arslan, Mehmet; Açar, Hali̇l İbrahi̇m; Cömert, Ayhan; Tubbs, R. Shane

doi:10.5137/1019-5149.jtn.19469-16.1

Cited by 12 publications

(11 citation statements)

References 22 publications

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“…The radiculomedullary artery supplies the spinal cord. Cadaveric studies have demonstrated cervical radicular arteries from the vertebral, ascending cervical, and deep cervical arteries [19]. The C6 radicular artery was larger.…”

Section: Review Of Literaturementioning

confidence: 99%

A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma

Unnithan¹

2019

Egypt J Neurosurg

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Background: There is a debate over the origin of bleeding in case of spontaneous spinal epidural hematoma (SSEH). The most widely accepted theory is of venous origin. Since the epidural veins are valveless, there will be increased venous pressure transmitted from intrathoracic and intraabdominal compartments on straining, causing rupture. Another view is that only arterial bleeding can cause rapid compression of spinal cord, since the venous pressure is less than intrathecal pressure. There is a lack of consensus on treatment also. Most of the authors recommend urgent decompressive laminectomy. There is a recent trend towards less invasive options such as partial laminectomy and hemilaminectomy and conservative treatment. Aim, materials, and methods: Aim of this study is to review the theories about the origin of bleeding in spontaneous spinal epidural hematoma and the methods of treatment. Literature search was done in PubMed for theories of the origin of spontaneous spinal epidural hematoma and the treatment methods. Descriptive analysis was done. Case presentation: A 49-year-old male stoneworker presented with thoracic back pain of acute onset while doing work, followed by weakness of forearm and legs. He had paraplegia with grade 1 power of lower limbs. MRI showed posterior epidural hematoma from C3 to T4. Midline partial laminectomy was done from C5 to T2. Hematoma was evacuated. His power improved over 1 week. Later CT (computed tomography) angiography showed no vascular malformation. Conclusion: Cervical location and rapid development of weakness point towards arterial origin of spontaneous spinal epidural hematoma. Thoracic location and presence of peroperative venous ooze suggest venous origin. Partial or hemilaminectomy is recommended to reduce postoperative instability. Conservative treatment is preferred in case of coagulopathy.

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Section: Review Of Literaturementioning

confidence: 99%

A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma

Unnithan¹

2019

Egypt J Neurosurg

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“…However, there has been almost no mention of needle size and safety in the literature. A recent cadaveric study has shown cervical radicular artery calibre to range from 0.75 to 1.02 mm and a case report has shown that these arteries can be inadvertently cannulated with small calibre 25G needles [23,24]. We prefer a larger calibre 22G needle, hypothesising that the larger needle is less likely to inadvertently cannulate small calibre radicular arteries than smaller 25G/26G needles.…”

Section: Discussionmentioning

confidence: 92%

The safety and efficiency of performing cervical transforaminal epidural steroid injections under fluoroscopic control on an ambulatory/outpatient basis

et al. 2019

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Purpose Cervical transforaminal epidural steroid injections (CTFESIs) have become an increasingly utilised means of treating radicular pain over recent decades, although a number of reports have brought their safety into question. Much of this has been attributed to the use of particulate steroids and the theoretical risk of embolic complications with inadvertent intra-arterial injection. This study documents the complications encountered at our centre when performing CTFESI over a more than 10-year study period with predominant use of particulate steroid. Our procedural technique is also described. This study aims to highlight the importance of operator technique first and foremost and how, with safe and reproducible technique that confidently avoids intra-arterial injection, CTFESI can be performed safely irrespective of the choice of steroid. Methods All patients undergoing CTFESI between January 2008 and August 2018 at our centre were prospectively recruited to the study, documenting total number of injections/procedures per patient, presence of/description of complications and severity and type of steroid administered. Results Five hundred and twenty-seven patients underwent 1047 procedures (1753 individual cervical levels injected) over the study period: 1011 procedures performed with particulate steroid (triamcinolone acetonide) and 36 performed with nonparticulate (dexamethasone). Only six complications were encountered, all spontaneously self-resolving without intervention and considered minor (grade 1). Conclusions With fastidious safe technique, CTFESI can be safe, efficacious and cost-effectively administered on an outpatient basis. Predominant use of particulate steroids did not lead to any significant complications.

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“…The present study also showed that the rate of occlusion by initial EVT was significantly lower in patients with cervical SDAVFs than in those with SDAVFs in other locations (P = 0.04). The reason for the higher rate of incomplete occlusion of cervical SDAVF by initial EVT is thought to be due to the presence of multiple feeders from the PICA in addition to those from the deep cervical artery 20 , 21 .…”

Section: Discussionmentioning

confidence: 99%

Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography

Lee

Kang

Kim

et al. 2021

Sci Rep

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Initial attempt of endovascular treatment (EVT) for spinal dural arteriovenous fistula (SDAVF) is preferred because of concurrent diagnosis and treatment. However, outcomes following further treatment with initial EVT are not well studied. We retrospectively reviewed 71 patients with SDAVF to evaluate treatment outcomes of SDAVF after an initial EVT attempt. Pretreatment and posttreatment functional states were assessed by the Aminoff-Logue scale (ALS). In the case of incomplete occlusion or recurrence, overall outcomes after further treatments were compared. Of the 71 patients, 56 underwent initial EVT. Complete occlusion was achieved by initial EVT in 37 of 56 patients (66.1%). Multiple feeders were more frequently observed in patients with incomplete occlusion than complete occlusion after initial EVT (73.7% vs. 27%, P < 0.001). Among 19 patients with incomplete occlusion upon initial EVT, 14 underwent additional surgery, 13 of whom (92.9%) obtained improved or stationary functional outcomes. Functional improvement was not observed in patients who had repeated EVT or follow-up without further treatment. Recurrence was observed in 8 of 37 patients with complete occlusion upon initial EVT. Additional surgery achieved improved functional outcomes in cases of incomplete occlusion of SDAVF after the initial EVT attempt or recurrence rather than repeated EVT or follow-up.

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

Abstract: Understanding the vascular supply to the cervical spinal cord is important for preventing serious complications such as spinal cord ischemia.

Cited by 12 publications

References 22 publications

A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma

A brief review of literature of spontaneous spinal epidural hematoma in the context of an idiopathic spinal epidural hematoma

The safety and efficiency of performing cervical transforaminal epidural steroid injections under fluoroscopic control on an ambulatory/outpatient basis

Treatment strategy to maximize the treatment outcome of spinal dural arteriovenous fistula after initial endovascular embolization attempt at diagnostic angiography

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