scholarly journals Evaluation of tortuous vertebral arteries before cervical spine surgery: illustrative case

2021 ◽  
Vol 1 (20) ◽  
Author(s):  
J. Manuel Sarmiento ◽  
Justin D. Cohen ◽  
Robin M. Babadjouni ◽  
Miguel D. Quintero-Consuegra ◽  
Nestor R. Gonzalez ◽  
...  
Keyword(s):  
At Risk ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Lateral Displacement ◽  
Posterior Instrumentation ◽  
Anatomical Variations ◽  
Illustrative Case ◽  
Transverse Foramen ◽  
Cervical Spine Surgery ◽  
Increased Risk

BACKGROUND Cervical spine surgery sometimes necessitates complex ventral/dorsal approaches or osteotomies that place the vertebral artery (VA) at risk of inadvertent injury. Tortuosity of the VA poses increased risk of vessel injury during anterior decompression or placement of posterior instrumentation. OBSERVATIONS In this report, the authors describe a patient with degenerative cervical spondylotic myelopathy and focal kyphotic deformity requiring corrective surgery via a combined ventral/dorsal approach. Computed tomography (CT) and CT angiography (CTA) of the spine identified a left medially enlarged C4 transverse foramen and tortuous VA V2 segment forming a potentially dangerous medial loop into the vertebral body, respectively. The patient’s presentation and management are described. LESSONS The course of the VA is variable, and a tortuous VA with significant medial or lateral displacement may be dangerous during ventral and dorsal approaches to the cervical spine. CTA of the cervical spine is warranted in cases in which atlantoaxial fixation is needed or suspicious transverse foramen morphology is identified to understand the course of the VA and identify anatomical variations that would put the VA at risk during cervical spine surgery.

scholarly journals The vertebral artery convergence to the cervical spine in elders

Folia Medica ◽  
2019 ◽  
Vol 61 (3) ◽  
pp. 377-383
Author(s):  
Banu Alicioglu ◽  
Nadir Gulekon
Keyword(s):  
Cervical Spine ◽  
Vertebral Artery ◽  
Anatomical Variations ◽  
The Elderly ◽  
Uncinate Process ◽  
Older Age ◽  
Age Group ◽  
Transverse Foramen ◽  
Cross Sectional ◽  
Cervical Spine Surgery

Background: In the older population, tortuosity of the vertebral artery (VA), uncovertebral joint (UVJ) osteoarthritis, and abnormal vertebral alignment may alter the normal anatomy. Aim: We aimed to determine the anatomical variations and relationships between the cervical segment of the VA and the cervical spine with regard to ageing. Materials and methods: In this retrospective cross-sectional study, the computed tomography angiography scans of 110 subjects were reviewed. Any variations in the VA, UVJ degeneration were identified. The distance between the VA and uncinate process (UP) was measured electronically. The distance between the VA and UP were compared according to the age group (group A > 45, group B = 45-65, and group C > 65 years-old). Results: With regard to the transverse foramen, 7.2% of the cases had entering abnormalities of the VA, while in one case (0.83%), the right VA had an exiting abnormality (exiting from the C2 instead of the C1). UVJ degeneration was found to be significantly higher in the older age group (p > 0.05). Furthermore, at the C4-C7 levels, the distances between the VA and UP were significantly smaller in the older age group (p > 0.01). Conclusions: The VA-UP distance has been shown to decrease due to increasing UVJ osteoarthritis in the elderly. The convergence of the VA toward the spine occurs at the most mobile segment of the cervical spine, and this anatomical alteration may predispose temporary and/or permanent vertebral artery occlusion clinically, and be dangerous during cervical spine surgery.

Anterolateral approach to the cervical spine: major anatomical structures and landmarks

2007 ◽  
Vol 7 (6) ◽  
pp. 669-678 ◽  
Author(s):  
Erdinc Civelek ◽  
Talat Kiris ◽  
Kemal Hepgul ◽  
Ali Canbolat ◽  
Gokhan Ersoy ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Anatomical Variations ◽  
Uncinate Process ◽  
Inferior Thyroid Artery ◽  
Cervical Region ◽  
Anterolateral Approach ◽  
Transverse Foramen ◽  
Cervical Spine Surgery ◽  
Cervical Sympathetic ◽  
The Sacrifice

Object The authors undertook a study to explore the topographic anatomical features seen during the anterolateral approach to cervical spine, anatomical variations, and certain landmarks related to the surgical procedure. Methods The study was conducted in 30 fresh cadavers. Results The common carotid artery bifurcation was mostly found at the level of C-4 (78%). The inferior belly of the omohyoid muscle was seen to cross the sternocleidomastoid muscle at the C5–6 disc level along the entire C-6 vertebral body. To reach the lower cervical region, the sacrifice of this muscle makes the procedure easier. The facial vein drained into the internal jugular vein mostly at the level of C3–4 (54%). The superior ganglion of the cervical sympathetic chain was located at the C-4 vertebra, but the location of the intermediate ganglion exhibited some variation. The vertebral artery entered the transverse foramen of C-6 in 27 cadavers (90%), the transverse foramen of C-7 in two cadavers (7%), and the transverse foramen of C-4 in one cadaver (3%). Because the inferior thyroid artery crossed the C6–7 interspace obliquely, the course of the inferior thyroid artery may complicate the procedure. The C-5 uncinate process was shortest and narrowest and had the greatest distance from the medial edge of the process to the anterior tubercle (p < 0.001). Conclusions Understanding the qualitative anatomy of this region not only improves the safety of anterior and anterolateral cervical spine surgery but also allows adequate decompression of neural elements and resolution of the other pathological processes of this region. In this fresh cadaveric study, our goal was to improve the approach and decrease the incidence of complications.

Immediate Voice and Swallowing Complaints Following Revision Anterior Cervical Spine Surgery

2020 ◽  
Vol 163 (4) ◽  
pp. 778-784
Author(s):  
Madeleine P. Strohl ◽  
Winward Choy ◽  
Aaron J. Clark ◽  
Praveen V. Mummaneni ◽  
Sanjay S. Dhall ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Postoperative Period ◽  
Care Center ◽  
Tertiary Care ◽  
Multivariate Logistic Regression Analysis ◽  
Cervical Spine Surgery ◽  
Anterior Cervical Spine Surgery ◽  
Increased Risk ◽  
Vocal Fold Motion

Objective To report on the incidence of dysphagia, dysphonia, and acute vocal fold motion impairment (VFMI) following revision anterior cervical spine surgery, as well as to identify risk factors associated with acute VFMI in the immediate postoperative period. Study Design Retrospective cohort study. Setting Tertiary care center. Subjects and Methods All patients who underwent 2-team reoperative anterior cervical discectomy and fusion (ACDF) were retrospectively reviewed. Incidence of dysphonia, dysphagia, and acute VFMI was noted. Patient and operative factors were evaluated for association with risk of acute VFMI. Results The incidence of postoperative dysphonia and dysphagia was 25% (18/72) and 52% (37/72), respectively. The incidence of immediate VFMI was 21% (15/72). Subjective postoperative dysphonia (odds ratio, [OR] 8; 95% CI, 2.2-28; P = .001) and dysphagia (OR, 22; 95% CI, 2.5-168; P = .005) were significantly associated with increased risk of VFMI. Three patients with VFMI required temporary injection medialization for voice complaints and/or aspiration. Infection (OR, 14; 95% CI, 1.4-147, P = .025) and level C7/T1 (OR, 5.5; 95% CI, 1.3-23, P = .02) were significantly associated with an increased risk of acute VFMI on multivariate logistic regression analysis. Number of prior surgeries, laterality of approach, side of approach relative to prior operations, and number of levels exposed were not significant. Conclusion Early involvement of an otolaryngologist in the care of a patient undergoing revision ACDF can be helpful to the patient in anticipation of voice and swallowing changes in the postoperative period. This may be particularly important in those being treated at C7/T1 or those with spinal infections.

Anatomical variations of the foramen transversarium in cervical vertebrae: findings, review of the literature, and clinical significance during cervical spine surgery

2016 ◽  
Vol 25 (12) ◽  
pp. 4132-4139 ◽  
Author(s):  
Aristeidis H. Zibis ◽  
Vasileios Mitrousias ◽  
Kyriaki Baxevanidou ◽  
Michael Hantes ◽  
Theofilos Karachalios ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Clinical Significance ◽  
Spine Surgery ◽  
Cervical Vertebrae ◽  
Anatomical Variations ◽  
Review Of The Literature ◽  
Cervical Spine Surgery

scholarly journals Underweight patients are an often under looked “At risk” population after undergoing posterior cervical spine surgery

2021 ◽  
Vol 5 ◽  
pp. 100041
Author(s):  
Taylor D. Ottesen ◽  
Paul S. Bagi ◽  
Rohil Malpani ◽  
Anoop R. Galivanche ◽  
Arya G. Varthi ◽  
...  
Keyword(s):  
At Risk ◽  
Cervical Spine ◽  
Spine Surgery ◽  
Risk Population ◽  
Cervical Spine Surgery ◽  
Underweight Patients

Application of Smith-Robinson approach for C2/3 cervical spine surgery

2013 ◽  
Vol 32 (11) ◽  
pp. 1199-1202
Author(s):  
Ying ZHANG ◽  
Jun MA ◽  
Yuan-yuan CHEN ◽  
Xin-wei WANG ◽  
De-yu CHEN ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Cervical Spine Surgery

scholarly journals Impact of Diabetes Mellitus on Cervical Spine Surgery for Ossification of the Posterior Longitudinal Ligament

2021 ◽  
Vol 10 (15) ◽  
pp. 3375
Author(s):  
Atsushi Kimura ◽  
Katsushi Takeshita ◽  
Toshitaka Yoshii ◽  
Satoru Egawa ◽  
Takashi Hirai ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Cervical Spine ◽  
Postoperative Complications ◽  
Spine Surgery ◽  
Posterior Longitudinal Ligament ◽  
Lower Extremity Function ◽  
Cervical Spine Surgery ◽  
The Impact

Ossification of the posterior longitudinal ligament (OPLL) is commonly associated with diabetes mellitus (DM); however, the impact of DM on cervical spine surgery for OPLL remains unclear. This study was performed to evaluate the influence of diabetes DM on the outcomes following cervical spine surgery for OPLL. In total, 478 patients with cervical OPLL who underwent surgical treatment were prospectively recruited from April 2015 to July 2017. Functional measurements were conducted at baseline and at 6 months, 1 year, and 2 years after surgery using JOA and JOACMEQ scores. The incidence of postoperative complications was categorized into early (≤30 days) and late (>30 days), depending on the time from surgery. From the initial group of 478 patients, 402 completed the 2-year follow-up and were included in the analysis. Of the 402 patients, 127 (32%) had DM as a comorbid disease. The overall incidence of postoperative complications was significantly higher in patients with DM than in patients without DM in both the early and late postoperative periods. The patients with DM had a significantly lower JOA score and JOACMEQ scores in the domains of lower extremity function and quality of life than those without DM at the 2-year follow-up.

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