Anterolateral approach to the cervical spine: major anatomical structures and landmarks. Technical note.
OBJECTIVE
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.
Civelek
Erdinc
E
Department of Neurosurgery, Istanbul University, Turkey. civsurgeon@yahoo.com
Kiris
Talat
T
Hepgul
Kemal
K
Canbolat
Ali
A
Ersoy
Gokhan
G
Cansever
Tufan
T
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001808:Blood Vessels / Q000033:anatomy & histology; D002102:Cadaver; D017536:Carotid Artery, Common / Q000033:anatomy & histology; D002574:Cervical Vertebrae / Q000033:anatomy & histology* / Q000098:blood supply / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009334:Neck Muscles / Q000033:anatomy & histology; D019635:Neurosurgical Procedures / Q000379:methods*; D013961:Thyroid Gland / Q000098:blood supply