Radiological determination of safe and adequate corpectomy limits in the cervical region
Radiological determination of safe and adequate corpectomy limits in the cervical region
Aim: This manuscript aims to display the relationship between the vertebral artery and its surrounding structures to maintain safeand effective corpectomy during anterior C4, C5, and C6 decompressive surgery.Material and Methods: Fifty patients who applied to the emergency department and received a cervical computed tomography(CT) scan were included, and their C4, C5, and C6 vertebrae margins were measured. The following distances were measured: thedistance between the medial wall of the vertebral foramen and lateral border of the anterior arch of the vertebral corpus, the distancebetween the junction of the corpus-the pedicle and inferior border of the vertebral foramen, the distance between the medial borderof the vertebral foramen and longus colli muscles, the distance between each vertebral foramen, and the bipedicular distance.Results: Fifty patients (22 females and 28 males) were assessed in this study. The female and male populations had mean ages of52.4 and 53.9 years, respectively. All measurements were higher in the lower vertebrae than those in the upper vertebrae. Also allthese measurements were found higher in males than females. The following results were reported: a value: C4, 4.1/4.3 (F/M); C5,4.6/4.9; and C6, 5/5.2 mm; b value: C4, 4.5/4.7; C5, 4.8/5.1; and C6, 5.1/5.5 mm; c value: C4, 8.6/9; C5, 9/9.6; and C6, 9.3/10.1 mm; dvalue: C4, 23.1/24; C5, 23.9/25.2; and C6, 24.5/25.5 mm; e value: C4, 19.3/20.4; C5, 20/21; and C6, 20.5/21.7 mm.Conclusion: The Distances between the vertebral artery and the surrounding structures and muscles will provide the surgeon a saferworking during anterior corpectomy surgery. These parameters should be taken into consideration during anterior corpectomy toobtain more secure and effective decompression.
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- 1. Smith GW, Robinson RA. The treatment of certain cervicalspine
disorders by anterior removal of the intervertebral disc
and interbody fusion. J. Bone Joint Surg Am 1958;40:607-
24.
- 2. Cloward RB. The anterior approach for removal of ruptured
cervical disks. J. Neurosurg 1958;15:602-17.
- 3. Steinmetz MP, Stewart TJ, Kager CD, et al. Cervical deformity
correction. Neurosurgery 2007;60:90-7.
- 4. Tan LA, Riew KD, Traynelis VC. Cervical spine deformity-
Part 2: Management algorithm and anterior techniques.
Neurosurgery 2017;81:561-7.
- 5. Miller JA, Lubelski D, Alvin MD, et al. C5 palsy after posterior
cervical decompression and fusion: cost and quality-of-life
implications. Spine J 2014;14:2854-60.
- 6. Minhas SV, Chow I, Jenkins TJ, at el. Preoperative predictors
of increased hospital costs in elective anterior cervical
fusions: a single-institution analysis of 1,082 patients.
Spine J 2015;15:841-8.
- 7. Nandyala SV, Elboghdady IM, Marquez-Lara A,et al. Cost
analysis of incidental durotomy in spine surgery. Spine
(Phila Pa 1976) 2014;39:E1042-E51.
- 8. Lunardini DJ, Eskander MS, Even JL, et al. Vertebral artery
injuries in cervical spine surgery. Spine J 2014;14:1520-5.
- 9. Rampersaud YR, Moro ER, Neary MA, et al. Intraoperative
adverse events and related postoperative complications
in spine surgery: implications for enhancing patient safety
founded on evidence-based protocols. Spine (Phila Pa
1976) 2006;31:1503-10.
- 10. Daentzer D, Deinsberger W, Boker DK. Vertebral artery
complications in anterior approaches to the cervical spine:
report of two cases and review of literature. Surg Neurol
2003;59:300-9.
- 11. Burke JP, Gerszten PC, Welch WC. Iatrogenic vertebral
artery injury during anterior cervical spine surgery. Spine J
2005;5:508-14.
- 12. Fassett DR, Dailey AT, Vaccaro AR. Vertebral artery injuries
associated with cervical spine injuries: a review of the
literature. J Spinal Disord Tech 2008;21:252-8.
- 13. Stemper BD, Yoganandan N, Pintar FA, et al. Anatomical
gender differences in cervical vertebrae of size-matched
volunteers, Spine 2008;33:E44-9.
- 14. David E, Youssef M, Khalil S, et al. Demographical aspects in
cervical vertebral bodies’ size and shape (c3-c7): a skeletal
study. Spine J 2017;17:135-142.
- 15. Herzo RG, Wiens JJ, Dillingham MF, et al. Normal cervical
spine morphometry and cervical spinal stenosis in
asymptomatic professional football players. Plain film
radiography, multiplanar computed tomography, and
magnetic resonance imaging, Spine 1991;16:S178-86.
- 16. Güvençer M, Naderi S, Men S, et al. Morphometric evaluation
of the uncinate process and its importance in surgical
approaches to the cervical spine: a cadaveric study.
Singapore Med J 2016;57:570-7.
- 17. Peng CW, Chou BT, Bendo JA, et al. Vertebral artery injury
in cervical spine surgery: anatomical considerations,
management, and preventive measures. Spine J 2009;9:70-
6.
- 18. Sanchis-Gimeno JA, Blanco-Perez E, Llido S, et al. Can
the transverse foramen/vertebral artery ratio of double
transverse foramen subjects be a risk for vertebrobasilar
transient ischemic attacks? J Anat 2018;7.
- 19. Nourbakhsh A, Yang J, Mcmahan H, et al. Transverse
process anatomy as a guide to vertebral artery exposure
during anterior cervical spine approach: a cadaveric study.
Clin Anat 2017;30:492-7.
- 20. Smith MD, Emery SE, Dudley A, et al. Vertebral artery injury
during anterior decompression of the cervical spine. A
retrospective review of ten patients. J Bone Joint Surg Br
1993;75:410-5.
- 21. Eskander MS, Drew JM, Aubin ME, at al. Vertebral artery
anatomy: a review of two hundred fifty magnetic resonance
imaging scans. Spine (Phila Pa 1976) 2010;35:2035-20-40.
- 22. Sarkar S, Nair BR, Rajshekhar V. Complications following
central corpectomy in 468 consecutive patients with
degenerative cervical spine disease. Neurosurg Focus
2016;40:E10.
- 23. Nooti Venkata Srinivasa Rao, Vedantam Rajshekhar,
Distal-type cervical spondylotic amyotrophy: incidence
and outcome after central corpectomy J Neurosurg Spine
2009;10:374-9.
- 24. Odate S, Shikata J, Yamamura S, et al. Extremely wide and
asymmetric anterior decompression causes postoperative
C5 palsy: an analysis of 32 patients with postoperative C5
palsy after anterior cervical decompression and fusion.
Spine (Phila Pa 1976) 2013;38:2184-9.