The safety zone of percutaneous cervical approach: a dynamic computed tomographic study

Area of Science:

• Anatomy
• Medical Imaging
• Surgical Safety

Background:

• Percutaneous cervical approaches risk injuring anterior neck structures.
• Dynamic anatomy of vital structures and risks associated with routine trajectories are not well-analyzed.

Purpose of the Study:

• To define the safety zone for percutaneous cervical approaches.
• To identify anatomical structures at risk during these procedures.

Main Methods:

• Prospective study utilizing computed tomography (CT) scans of 30 patients.
• CT scans acquired at cervical intervertebral disc levels (C3-C4 to C6-C7) with simulated discography.
• Measurement of distances to digestive tract and carotid artery to determine safety zone and identify structures at risk.

Main Results:

• Safety zone dimensions varied by level, widening distally (C5-C6, C6-C7).
• Superior thyroidal artery (STA) and thyroid gland (TG) were frequently within the safety zone at specific levels.
• At C3-C4, STA was in the safety zone in 86.7%; at C6-C7, TG was on the approach plane in 90%.

Conclusions:

• The safety zone is wider at lower cervical levels (C5-C6, C6-C7).
• Optimal needle entry is between the airway and carotid artery, directed towards the disc center.
• Percutaneous cervical approach is a safe diagnostic technique with low risk of pharyngoesophageal injury.