Cervical venous structure in the inter-transverse and intra-transverse foraminal region: an anatomic study

Vertebral venous bleeding is frequently encountered during anterolateral cervical decompression. The present study was undertaken to identify the pattern and location of the vertebral vein in relationship to the vertebral artery in the inter-transverse and intra-transverse foraminal regions. Twenty-one cadavers were dissected to determine the anatomic features of the vertebral vein in the inter-transverse and intra-transverse foramina. The vertebral veins in the inter-foraminal and intraforaminal regions from C-3 to C-6 can be classified into three types: single or double veins, venous plexus, and absence of the vein. Of the 21 specimens, vertebral veins were found bilaterally in five specimens (24%) and unilaterally in eight specimens (38%). The veins were situated either anterolateral or anteromedial to the vertebral artery. The venous structures showed in venous plexus in two specimens (9.5%). In six specimens (29%), there were no obvious venous structures related to the vertebral artery in its intra-transverse and inter-transverse foraminal course. The veins are contained in a fibrous and osseous tunnel as they descend through the transverse foramina. Subperiosteal dissection of fibrous tissue from the lateral aspect of the uncinate process after removal of the anterior wall of the transverse foramen may minimize hemorrhages from the vertebral vein in the inter-transverse and intra-transverse foraminal region during resection of the uncovertebraljoint or neural foraminotomy with retraction of the vertebral artery laterally.