Oh S H, Perin N I, Cooper P R
Department of Neurosurgery, University of Cincinnati College of Medicine, Ohio, USA.
Neurosurgery. 1996 Jun;38(6):1139-44. doi: 10.1097/00006123-199606000-00016.
Knowledge of the quantitative anatomy of the subaxial cervical vertebrae is essential to safely perform anterior cervical surgery and to ensure adequate decompression of neural structures. In spite of this, little has been published in the neurosurgical literature regarding the spatial relationship of the lower cervical vertebrae and the implications of this anatomy for anterior cervical surgery. We report the three-dimensional analysis of the mid- and lower cervical spine in 10 cadaver specimens for 50 disarticulated vertebrae and discuss the relevance of this analysis to surgery in this region. Measurements were made using real-time video analysis of images transferred from a Zeiss microscope equipped with an image splitter and a Sony charge-coupled device camera. Images were then transferred to an IBM personal computer-based image analysis system. Analysis of variance was used to test for significant differences among the C3-C7 vertebral measurements. Important relationships of the vertebral artery to the anteroposterior diameter of the vertebral bodies and its variations from C3 to C7 are discussed. The vertebral artery migrates posteriorly to anteriorly from C3 to C6 and posteriorly again at C7; the implications of these variations are discussed for decompression of the neural foramen. Another finding showing that the inter-Luschka distance increases from C3 to C7 is important for adequate lateral decompression in anterior cervical spinal surgery. The pedicle to the Luschka joint was measured at the different levels; the pedicle is lateral to the Luschka joint from C3 to C6 and medial to the joint at C7. This variation explains the lack of root decompression at some cervical levels, even when decompression extends to the Luschka joint bilaterally. We also report the measurements of the vertebral bodies and the spinal canal and compare the results with other published data. We think these measurements provide guidelines for operating on the anterior cervical spine, facilitate adequate decompression of the spinal cord and neural foramen, and increase the margin of safety of the surgeon.
了解下颈椎的定量解剖结构对于安全开展颈椎前路手术以及确保神经结构得到充分减压至关重要。尽管如此，神经外科文献中关于下颈椎的空间关系及其解剖结构对颈椎前路手术的影响的报道却很少。我们报告了对10具尸体标本中的50个分离椎体进行的中下颈椎三维分析，并讨论了该分析与该区域手术的相关性。测量使用配备图像分割器的蔡司显微镜和索尼电荷耦合器件相机传输的图像进行实时视频分析。然后将图像传输到基于IBM个人计算机的图像分析系统。采用方差分析来检验C3 - C7椎体测量值之间的显著差异。讨论了椎动脉与椎体前后径的重要关系及其从C3到C7的变化。椎动脉从C3到C6向后向前迁移，在C7处再次向后；讨论了这些变化对神经孔减压的影响。另一个发现是钩椎间距从C3到C7增加，这对于颈椎前路手术中充分的外侧减压很重要。在不同水平测量椎弓根到钩椎关节的距离；从C3到C6椎弓根在钩椎关节外侧，在C7处则在关节内侧。这种变化解释了即使双侧减压延伸到钩椎关节，在某些颈椎水平仍缺乏神经根减压的原因。我们还报告了椎体和椎管的测量结果，并将结果与其他已发表的数据进行比较。我们认为这些测量为颈椎前路手术提供了指导，有助于脊髓和神经孔的充分减压，并增加了外科医生的安全 margin 。 （最后一句“margin”结合语境可能是“安全边际”之类的意思，但不确定准确含义，按要求未添加解释）
