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Vulnerability of vertebral artery in anterolateral decompression for cervical spondylosis
N A Ebraheim1, J Lu, J A Brown
1Department of Orthopaedic Surgery, Medical College of Ohio, Toledo 43614, USA.
Insights
This study provides crucial anatomical data for safe lateral cervical decompression, identifying risks to the vertebral artery (VA) in upper cervical spine surgery. Findings guide optimal surgical approaches to minimize VA injury during decompression procedures.
Area of Science:
- Neurosurgery
- Anatomy
- Spine Surgery
Background:
- Vertebral artery (VA) injury is a significant risk during lateral cervical decompression.
- Limited anatomical data exists on the safe zone for uncinate process resection.
- Understanding the relationship between cervical anatomy and the VA is critical for surgical safety.
Purpose of the Study:
- To provide detailed anatomical measurements of the upper cervical spine relevant to the vertebral artery.
- To identify an optimal surgical approach for lateral cervical decompression that minimizes the risk of vertebral artery injury.
- To document the safe zone for uncinate process and uncovertebral joint resection.
Main Methods:
- Measurement of transverse foramina and related parameters on dry cervical spines (C3-C7).
- Cadaveric dissection to determine a safer method for uncovertebral joint resection.
- Analysis of anatomical distances including interforaminal and interuncinate distances.
Main Results:
- Transverse foramina diameters decrease from C6 to C3; C5 shows smaller transverse diameters.
- Caudal-to-cranial measurements (interforaminal, interuncinate distances) decrease in higher cervical vertebrae.
- Subtotal vertebrectomy and anterior wall opening of transverse foramina facilitate safer decompression.
Conclusions:
- The vertebral artery is at increased risk during decompression of the more cephalad cervical vertebrae.
- Lateral cervical decompression can be safely performed using direct visualization with smaller instruments after anterior wall deroofing.
- Anatomical data supports modified surgical techniques to enhance safety and reduce vertebral artery injury.
Abstract:
This study aimed to provide anatomic data for the location of the vertebral artery and offer an optimal approach for lateral cervical decompression that minimizes the risk of injury to the vertebral artery. Anatomically, there has been little study documenting the safe zone to prevent vertebral artery injury during the resection of the uncinate process or uncovertebral joint during the lateral decompression of the nerve root. The transverse foramen and its related parameters were measured on dry cervical spines from C3 to C7. The cadaveric cervical spines were dissected to determine a method for resection of the uncovertebral joint with decreased risk of vertebral artery laceration. The anteroposterior diameters of the transverse foramina gradually decreased from C6 to C3. The transverse diameters of the transverse foramina were smaller at C5. The interforaminal distance, width of the vertebrae, interuncinate distance, and the distance from the lateral tip of the uncinate process to the medial border of the transverse foramen became smaller in more cephalad vertebrae. After subtotal vertebrectomy and opening of the anterior walls of the transverse foramina, the resection of the uncovertebral joint and lateral decompression became easier and safer. Anatomic measurements obtained in this study indicate the vertebral artery to be at risk during decompression of the more cephalad vertebrae. The lateral decompression can be completed under direct vision with smaller rongeurs and curettes, rather than with high speed burr after deroofing the anterior walls of transverse foramina and retracting the vertebral artery laterally.