Pait T G, Killefer J A, Arnautovic K I
Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, USA.
Neurosurgery. 1996 Oct;39(4):769-76. doi: 10.1097/00006123-199610000-00026.
To elucidate the relationships between the neurovascular structures and surrounding bone, which are hidden from the surgeon by soft tissue, and to aid in avoiding nerve root and vertebral artery injury in anterior cervical spine surgery.
Using six cadaveric spines, we measured important landmarks on the anterior surface of the spine, the bony housing protecting the neurovascular structures in the lateral disc space, and the changes that occur during the discectomy with interbody distraction of the vertebral bodies. The measurements included the distance between the medial borders of the longus colli muscle at the level of each interspace; the width and height of each disc space at the midline; the width and height of the costal process; the distances between the cranial tip of the uncinate process (UP) and the vertebral body (VB) above and from the tip of the UP to the vertebral artery; the anteroposterior diameter or the extent of the disc spaces in the midline; the height at the midpoint of the distracted disc space; the UP-VB distance in distraction; and the width of the visible nerve root.
The distance between the medial borders of the longus colli muscles increased in a rostral to caudal direction. The height of the UP was shortest at C4-C5 and greatest at C5-C6; the width was narrowest at C4-C5 and widest at C6-C7. The width of the costal process measured from the VB to the anterior tubercle was narrowest at C2-C3 and widest at C6-C7. The midpoint height of the costal process was smallest at C6-C7 and tallest at C4-C5 and C5-C6. The nondistracted UP-vertebral artery distance was the shortest at C2-C3 and longest at C4-C5. The nondistracted UP-VB distance averaged 1 mm at C2-C3 and C6-C7 and 1.5 mm at C4-C5. The height of the distracted disc space was shortest at C2-C3 and C6-C7. The UP-VB distance after distraction was greatest at C4-C5. Only at the C2-C3 interspace was the nerve always above the process. The vertebral artery entered the foramen transversarium of C6 in all the specimens.
Although avoiding unfortunate injury is not always possible, understanding the locations and relations among the anatomic features is the only safeguard against unwarranted damage.
阐明神经血管结构与周围骨骼之间的关系，这些结构被软组织遮挡，外科医生难以看到，以帮助在颈椎前路手术中避免神经根和椎动脉损伤。
使用六个尸体脊柱，我们测量了脊柱前表面的重要标志、保护外侧椎间盘间隙神经血管结构的骨性结构以及椎体椎间撑开椎间盘切除术过程中发生的变化。测量包括每个间隙水平胸锁乳突肌内侧边界之间的距离；每个椎间盘间隙在中线处的宽度和高度；肋突的宽度和高度；钩突（UP）颅端与上方椎体（VB）之间以及从UP尖端到椎动脉的距离；中线处椎间盘间隙的前后直径或范围；撑开后椎间盘间隙中点的高度；撑开时UP-VB距离；以及可见神经根的宽度。
胸锁乳突肌内侧边界之间的距离从颅侧向尾侧方向增加。UP的高度在C4-C5处最短，在C5-C6处最长；宽度在C4-C5处最窄，在C6-C7处最宽。从VB到前结节测量的肋突宽度在C2-C3处最窄，在C6-C7处最宽。肋突中点高度在C6-C7处最小，在C4-C5和C5-C6处最高。未撑开时UP-椎动脉距离在C2-C3处最短，在C4-C5处最长。未撑开时UP-VB距离在C2-C3和C6-C7处平均为1mm，在C4-C5处为1.5mm。撑开后椎间盘间隙高度在C2-C3和C6-C7处最短。撑开后UP-VB距离在C4-C5处最大。仅在C2-C3间隙，神经总是在突起上方。所有标本中椎动脉均进入C6横突孔。
虽然并非总能避免不幸的损伤，但了解解剖特征的位置和关系是防止不必要损伤的唯一保障。
