Microsurgical Anatomy of the Lower Cervical Spine and Cord

Introduction:The literature is lacking information on the anatomy and the osseous dimensions of the thoracic intervertebral foramen (IVF). We describe the anatomy of the broader area, and we proceed with morphometric data of the vertebrae and the foramina. Depiction of these features is provided with imaging and illustrations. The purpose of this paper is to survey and present the anatomy of the foramen as a whole and provide baseline statistical data.Materials and Methods:We review relevant literature, and we present data obtained from skeletal samples of known population and sex. One hundred and nineteen thoracic vertebrae of ten cadaveric spines from the prefecture of Eastern Macedonia and Thrace, Greece, were selected. Statistical analysis measuring the vertical height and the foraminal width of each vertebra was made in accordance with sex.Results:No statistically important differences referring to the descriptive data of both sexes were found. However, statistically, important positive correlation between the vertebral height and the foraminal width was observed, especially for men. The components of the foramen including arteries and veins passing through or neighboring it, and the spinal nerves and roots are described and depicted.Conclusions:The osseous thoracic IVF reveals a glimpse of the in vivo structure and alterations of its width may be present in back pain and other degenerative diseases. Although it is crucial for surgeries and other interventional procedures of the thoracic spine, little is known about the precise anatomy and dimensions of this anatomical landmark.

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“…[61516] Kirazli et al . found that the average number of dorsal thoracic rootlets is 6.6 ± 0.8, which is higher than what Sindou found.…”

Section: Resultsmentioning

confidence: 99%

“…found an average of 6.8 T1 segment rootlets in their study which corresponded with the results of three other separate studies. [15181920] In addition, they found that T1 segment contained the largest number of thoracic nerve rootlets, in contrast to the T6, T7, and T10 segments which contained the fewest. [19] Kirazli et al .…”

Section: Resultsmentioning

confidence: 99%

Clinical anatomy and significance of the thoracic intervertebral foramen: A cadaveric study and review of the literature

Gkasdaris

Trιpsianis

Kotopoulos

et al. 2016

J Craniovert Jun Spine

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“…Distal to the origin it ascended slightly medially in the spinal canal, dorsal to the deep layer of the posterior longitudinal ligament (PLL), and the ventral surface of the anterior internal vertebral venous plexus 12 (figure 1B-E). Rostrally, it gradual tapered, and penetrated the tectorial membrane, the upper extent of the PLL, just above the upper margin of the horizontal part of the cruciform ligament (figure 2A).…”

Section: Resultsmentioning

confidence: 99%

The So-Called Anterior Meningeal Artery: An Anatomic Study for Treatment Modalities

Shimizu

Garcia²,

Tanrıöver³

et al. 2004

Interv Neuroradiol

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The so called anterior meningeal artery (AMA) is a branch of the vertebral artery (VA), which had been interpreted as a supplying vessel of the dura in the foramen magnum and upper cervical level. In this study, we examined the anatomy of this artery and relationships to its surrounding structures for treatment modalities. With the aid of magnification, five adult cadaveric head and neck complex and five cervical spines were examined after perfusion of the vessels with colored silicone. The AMA arose from the VA between the C2 and C3 level, and passed medially through the intrervertebral foramen anterior to the dural sheath of the third cervical nerve root. It ran upwards dorsal to the deep layer of the posterior longitudinal ligament (PLL) with anterior internal vertebral venous plexus. Rostrally, it formed an arcade above the apex of the odontoid process with its contralateral mate. The AMA gave off several tiny branches to the deep layer of the PLL, ligaments and soft tissues above the apex of the odontoid process, and vertebral bodies of the axis. At the level of the foramen magnum, it ended in several small twigs to the dura. Anastomoses between the AMA system and adjacent vessels were observed. One was directed through the hypoglossal canal to the ascending pharyngeal artery and the other was with the V3 segment of the VA. The origin and course of the two AMA, and anastomoses were symmetric. Although the AMA feeds the ventral dura of the foramen magnum, the perfusion area is larger than its name suggests, including the bony and ligamentous structures in the craniovertebral junction. Anatomical knowledge of the AMA, including its anastomoses and layer relationships to the surrounding structures, may help to perform treatment modalities in this region rationally.

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“…The periradicular foraminal space is small and contains some fibrotic tissue. In particular, the superficial layer of the posterior longitudinal ligament is connected to the periradicular sheath anchoring the pedicle (17). When the needle tip is located in the small periradicular foraminal space, the contrast could initially collect on one side of the periradicular space without spreading to the other side around the nerve root.…”

Section: Discussionmentioning

confidence: 99%

Cervical Transforaminal Epidural Steroid Injection (TFESI): Role of MR Imaging and Epidurography

Choi

Ahn

Kim

et al. 2011

J Korean Soc Radiol

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Cervical transforaminal epidural steroid injections (TFESIs) play an important role in the conservative treatment of the symptoms of neck pain with a radicular component secondary to cervical herniated intervertebral disc (HIVD) or spinal stenosis (1-3). Although some investigators have reported no serious complications resulting from the use of cervical TFESIs, recent reports emphasize the risks of this procedure, including a high incidence of intravascular penetration (4) and serious brain and spinal cord injury (5-7). Therefore, it is important to consider the risks and benefits of TFESI. MR imaging of the cervical spine combined with plain radiography represents the reference-standard examina- Purpose: To evaluate the relationship between MR/epidurographic findings and the clinical outcome after a fluoroscopy-guided transforaminal epidural steroid injection (TFESI) in patients with cervical radicular pain. Materials and Methods: Forty-five patients who had taken a cervical TFESI in our department were included in this study. We retrospectively reviewed MR and epidurographic findings to see if there was a relationship between these methods and the amount of pain relief, by way of a multiple regression analysis. Results: On MR imaging, there was significant relationship between the amount of pain relief and location of herniated intervertebral disc (HIVD, central: 54.4%, lateral recess: 69.4%, foraminal: 59%; p = 0.048). There was no significant difference regarding the other MR findings. On epidurographic findings, there was significant difference in the amount of pain relief with the extent of the contrast (epidural and epineural space, 65.3%; epineural space only, 64.2%; p = 0.03) and location of the needle tip (in the foramen, 59.4%; outside the foramen, 68.4%; p = 0.002). Conclusion:The results indicate that TFESI could be more useful in patients with cervical HIVD in lateral recess rather than another location. Contrast spread into epidural reflux appears to be a favorable injection pattern. Needle tip location is recommended outside the foramen rather than in the foramen.

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Microsurgical Anatomy of the Lower Cervical Spine and Cord

Cited by 12 publications

References 14 publications

Clinical anatomy and significance of the thoracic intervertebral foramen: A cadaveric study and review of the literature

Clinical anatomy and significance of the thoracic intervertebral foramen: A cadaveric study and review of the literature

The So-Called Anterior Meningeal Artery: An Anatomic Study for Treatment Modalities

Cervical Transforaminal Epidural Steroid Injection (TFESI): Role of MR Imaging and Epidurography

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