title: The efficacy of carotid tubercle as an anatomical landmark for identification of cervical spinal level in the anterior cervical surgery: comparison with preoperative C-arm fluoroscopy.
abstract: BACKGROUND
  In cervical anterior approach, transverse skin incision is preferred due to cosmetic reasons. Precise skin incision is required to reach the surgery segment while minimizing soft tissue injury. Skin incision site is frequently identified using C-arm fluoroscopy or the carotid tubercle. Accordingly, this study was conducted to investigate the efficacy of skin incision using the carotid tubercle as a marker.
  
  
  METHODS
  This study was retrospectively conducted on 114 patients who underwent anterior cervical surgery by the same surgeon from April 2004 to June 2012. The rate of the appropriate insertion of K-wire, which was inserted into the disc after anterior approach, into the surgery segment was compared between 62 patients where skin incision site was identified using C-arm fluoroscopy before skin incision and 52 patients where skin incision site was identified using carotid tubercle palpitation before surgery.
  
  
  RESULTS
  The needle was shown to have been inserted into the planned site in 106 patients out of the total 114 patients. The appropriate insertion of the needle was shown in 59 patients of group I (95.2%) and in 47 patients of group II (90.4%). Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of one-segment surgery was shown to be 89.7% in group I and 82.6% in group II. Although the success rate was higher in group I than group II, it was statistically insignificant. The success rate of two-segment surgery was shown to be 100% in group I, and 96.4% in group II due to one case of the failure at C3-4 and C5-6. The success rate of three- and four-segment surgeries was shown to be 100% in both groups.
  
  
  CONCLUSIONS
  The identification of skin incision site via carotid tubercle palpation was useful for surgeries involving two or more segments. Furthermore, it could be useful for one-segment surgery if surgical site is identified using vertebral body or soft tissues such as longus collis rather than insertion into the disc.
authors.affiliation: Department of Orthopedic Surgery, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jae Hyup
authors.initials: JH
authors.lastname: Lee
authors.forename: Ji-Ho
authors.initials: JH
authors.lastname: Lee
authors.forename: Hyeong-Seok
authors.initials: HS
authors.lastname: Lee
authors.forename: Do-Yoon
authors.initials: DY
authors.lastname: Lee
authors.forename: Dong-Oh
authors.initials: DO
authors.lastname: Lee
mesh_terms: D000328:Adult; D059925:Anatomic Landmarks / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D002574:Cervical Vertebrae / Q000033:anatomy & histology* / Q000000981:diagnostic imaging / Q000601:surgery*; D005260:Female; D005471:Fluoroscopy / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010173:Palpation / Q000379:methods*; D012189:Retrospective Studies
keywords: Anatomical landmark; Anterior cervical surgery; Carotid tubercle; Skin incision