title: Prevertebral vascular and esophageal consideration during percutaneous cervical disc procedures.
abstract: METHODS
  A retrospective review series.
  
  
  OBJECTIVE
  To identify vascular anatomy and esophageal deviations that may interfere with a percutaneous anterior approach in cervical spine surgery.
  
  
  BACKGROUND
  The percutaneous anterior approach has been used for minimally invasive interventions of cervical disc diseases. Although the percutaneous anterior approach is frequently performed, reports of obstructing anatomical structures and procedural risks are limited.
  
  
  METHODS
  Cervical magnetic resonance images obtained from December 2012 to April 2013 from a total of 511 patients at Guro Teun Teun Hospital were evaluated in this study. Each axial T2-weighted MR image from the disc levels of C3-C4 to C6-C7 (total, 3066 images) was reviewed to check for the presence of small vessels along the trajectories of percutaneous cervical procedures on the left and right sides. Esophageal deviation was also measured at level C6-C7.
  
  
  RESULTS
  Small vessels in the anterior neck were present, respectively, in 50.5% (trajectory on the left side) and in 49.1% (trajectory on the right side) at disc level C3-C4, in 30.3% and 28.8% at C4-C5, in 24.1% and 7.6% at C5-C6, and in 55.2% and 43.1% at C6-C7. There were no differences in the number of small vessels between the left and right sides at the upper cervical level (C3-C4-C5), but small vessels were less frequently observed on the right side at lower cervical levels (C5-C6-C7). Differences in esophageal deviation were also observed, with less deviation to the right side (0.63 ± 0.35 cm) than the left (1.18 ± 0.52 cm). As well, an esophageal diverticulum was observed in 1 case on the left side.
  
  
  CONCLUSIONS
  Although surgical approaches are mostly concerned with the location of pathology to be removed, a right-sided percutaneous approach seems preferable because poses less of a risk of encountering small vessels and causing esophageal injury.
  
  
  METHODS
  4.
authors.affiliation: *Department of Neurosurgery, Spine and Joint Research Institute, Guro Teun Teun Hospital, Seoul, Korea †Department of Neurosurgery, Daegu Teun Teun Hospital, Daegu, Korea ‡Department of Diagnostic Radiology, Guro Teun Teun Hospital, Seoul, Korea; and §Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University, College of Medicine, Seoul, Korea.
authors.forename: Jae Kyun
authors.initials: JK
authors.lastname: Jeon
authors.forename: Chang Hyun
authors.initials: CH
authors.lastname: Oh
authors.forename: Daeyeong
authors.initials: D
authors.lastname: Chung
authors.forename: Junho
authors.initials: J
authors.lastname: Lee
authors.forename: Seung Hyun
authors.initials: SH
authors.lastname: Choi
authors.forename: Eunhwa
authors.initials: E
authors.lastname: Choi
authors.forename: Gyu Yeul
authors.initials: GY
authors.lastname: Ji
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D017586:Diskectomy / Q000379:methods*; D004947:Esophagus / Q000473:pathology*; D005260:Female; D006801:Humans; D007403:Intervertebral Disc / Q000473:pathology / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000098:blood supply* / Q000473:pathology; D012189:Retrospective Studies; D055815:Young Adult