Prevertebral Vascular and Esophageal Consideration During Percutaneous Cervical Disc Procedures

Jeon, Jae Kyun; Oh, Chang Hyun; Chung, Daeyeong; Lee, Jun-Ho; Choi, Seung Hyun; Choi, Eunhwa; Ji, Gyu Yeul

doi:10.1097/brs.0000000000000140

Cited by 4 publications

(5 citation statements)

References 12 publications

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“…Differences in oesophageal deviation were also observed, with less deviation to the right side (0.63 ± 0.35 cm) than the left (1.18 ± 0.52 cm). An oesophageal diverticulum was also observed in 1 case on the left side 12 .…”

Section: Discussionmentioning

confidence: 88%

Our experience of a left-sided approach to anterior cervical discectomy

Bozkurt

Karademir

2019

Cumhuriyet Medical Journal

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To emphasize the advantages of a left-sided approach compared to opening the cervical region from the right side in patients with cervical disc hernia undergoing surgery for any reason. Method: A total of 10 patients with a history of surgery in the right cervical region were operated on with a left-side approach because of disc hernia at a single cervical level between 2013 and 2018. The patients comprised 6 males and 4 females. Of the whole patient group, 5 had previously undergone surgery for cervical disc hernia, 3 for goitre, 1 with hydrocephalus because the shunt traversed the medial of the distal end of the sternocleidomastoid muscle, and 1 patient who had not been operated on but had goitre of giant dimensions extending to the right. Results: All the patients were diagnosed with cervical disc hernia from MRI findings and neurological examination. The operation of single level cervical disc surgery was performed with an approach from the left in all 10 patients avoiding opening from a recurrence area. No complications developed and the complaints were seen to recover. Conclusions: In the light of previous reports in literature, it can be emphasized that to prevent complications in cervical disc surgery, rather than an approach from a previously operated region, it could be more advantageous to open from the opposite side.

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Section: Discussionmentioning

confidence: 88%

Our experience of a left-sided approach to anterior cervical discectomy

Bozkurt

Karademir

2019

Cumhuriyet Medical Journal

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“…Additionally, a large retrospective radiographic study of percutaneous intervention from Jeon et al found that the left C5–6 levels had a significantly higher incidence of vascular structures in the prevertebral areas, thus potentially contributing to our patient’s postoperative complication because her primary intervention was on the left. 5 …”

Section: Discussionmentioning

confidence: 99%

“…Additionally, a large retrospective radiographic study of percutaneous intervention from Jeon et al found that the left C5-6 levels had a significantly higher incidence of vascular structures in the prevertebral areas, thus potentially contributing to our patient's postoperative complication because her primary intervention was on the left. 5 Management of such complications have not, to date, been reported in the literature, likely because of the novelty of this technique and overall complication infrequency. We do, however, argue for managing these patients in a fashion similar to those for comparable injuries after classic anterior approaches.…”

Section: Lessonsmentioning

confidence: 99%

“… 4 These complications include carotid injury, esophageal injury, and prevertebral hematoma formation. 1 , 4 , 5 …”

mentioning

confidence: 99%

“…4 These complications include carotid injury, esophageal injury, and prevertebral hematoma formation. 1,4,5 In this case lesson, we discuss the management of a patient who presented with acute-onset dysphonia and dyspnea following a percutaneous endoscope-assisted anterior cervical discectomy and was found to have a large prevertebral hematoma with an associated carotid injury. To our knowledge, this is the first report proposing a detailed management paradigm for such a complication.…”

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confidence: 99%

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Large prevertebral hematoma and carotid pseudoaneurysm following percutaneous anterior cervical discectomy: illustrative case

Basil

Sprau

Starke

et al. 2021

Journal of Neurosurgery: Case Lessons

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BACKGROUNDThe percutaneous, endoscope-assisted anterior cervical discectomy is a relatively new procedure, and because of its novelty, complications are minimal and pertinent literature is scarce. This approach relies on a sufficient anatomical understanding of the vital neurovascular structures in the operating workspace. Although complications are rare, they can be significant.OBSERVATIONSThe patient presented with difficulty breathing following an anterior percutaneous cervical discectomy performed at an outpatient surgical center. Imaging revealed a prevertebral hematoma and multiple carotid pseudoaneurysms. Given the large prevertebral hematoma and concern for imminent airway collapse, the authors proceeded with emergent intubation and surgical evacuation of the clot.LESSONSThe authors propose managing complications in a fashion similar to those for comparable injuries after classic anterior approaches. Definitive management of our patient’s carotid injury would require stenting and, therefore, dual antiplatelet agents. Thus, the authors proceeded with the hematoma evacuation first. Additionally, careful dissection was needed to decrease further carotid damage. Thus, the authors made a more rostral incision to maintain the given stability of the carotid insult before the angiographic intervention to follow. It is the authors’ hope that the technical pearls from this two-staged open hematoma evacuation and endovascular stenting may guide future presurgical and intraoperative planning and management of complications, should they arise.

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