Anatomical Importance Between Neural Structure and Bony Landmark in Neuroventral Decompression for Posterior...

Area of Science:

• Neurosurgery
• Spinal Anatomy
• Minimally Invasive Spine Surgery

Background:

• Accurate anatomical knowledge of the cervical spine is crucial for successful surgical outcomes.
• Posterior endoscopic cervical discectomy (PECD) offers a minimally invasive approach, but requires precise navigation.
• Understanding the relationship between nerve roots, pedicles, and intervertebral spaces is vital for neuroventral decompression.

Purpose of the Study:

• To investigate the detailed anatomical relationships within the cervical spine.
• To identify optimal pathways for neuroventral decompression in PECD.
• To enhance operative outcomes and safety in PECD procedures.

Main Methods:

• Multiplane reconstruction of cervical computed tomography myelography data.
• Measurement of nerve root width (WN), nerve root-pedicle distances (NSPD, NIPD).
• Analysis of intervertebral space-nerve root relationships (shoulder, anterior, axillary) and descending rootlet angles (VRA, DRA).

Main Results:

• Nerve root width (WN) increased caudally (C4-C7) and was larger in males.
• Nerve root-superior pedicle distance (NSPD) decreased caudally, while nerve root-inferior pedicle distance (NIPD) increased, with significant gender and age variations.
• The axillary nerve root relationship was more prevalent caudally, suggesting a potentially safer decompression corridor.

Conclusions:

• Precise anatomical understanding is essential for safe neuroventral decompression in PECD.
• The axillary nerve root pathway provides a safer and more effective route for direct neuroventral decompression compared to the shoulder approach.
• These findings can guide surgical planning and improve outcomes in PECD.