Summary
Vertebral artery injury is a serious complication during anterior surgery on the cervical spine. However, little information is available in the literature concerning the mechanism of vertebral artery laceration during the procedures of the anterior cervical decompression. In the current study twenty-eight cadavers were dissected to determine the location and relationships of the fibro-ligamentous tissues to the uncinate process, vertebral artery and nerve roots from the C3 to C6 levels. The vertebral artery and nerve root are encased by a fibro-ligamentous band at the level of the intertransverse space. This fibro-ligamentous band is attached to the lateral aspect of the uncinate process and uncovertebral joint, which combines the vertebral artery, nerve root and uncinate process to form a complex or unit. The fibro-ligamentous tissues between the uncovertebral joint and vertebral artery may explain the propensity to vertebral artery laceration during resection of the uncinate process or an osteophyte projecting from the uncovertebral joint. For this reason, the authors recommend that before resection of the uncinate process or uncovertebral joint is performed, it is necessary to thoroughly dissect the fibro-ligamentous tissues off the uncinate process.
Résumé
La blessure de l'artère vertébrale est une complication sérieuse au cours de la chirurgie antérieure de la colonne cervicale. Néanmoins, peu d'informations sont disponibles dans la littérature concernant les mécanismes de lacération de l'artère vertébrale au cours des gestes de décompression cervicale antérieure. Dans ce travail, 28 cadavres ont été étudiés pour déterminer la localisation et les relations du tissu fibro-ligamentaire en rapport avec l'uncus, l'artère vertébrale et les racines de C3 à C6. L'artère vertébrale et la racine sont entourées par des bandes de tissu fibro-ligamentaire au niveau de l'espace intertransversaire. Ces structures fibro-ligamentaires sont amarrées à la face latérale de l'uncus et de l'articulation uncovertébrale et réunissent l'artère vertébrale, la racine et l'uncus pour former une entité bien particulière. Ces structures fibro-ligamentaires entre l'articulation uncovertébrale et l'artère vertébrale peuvent expliquer les risques de lacération de l'artère vertébrale au cours de la résection de l'uncus ou des ostéophytes se projetant au niveau de l'articulation uncovertébrale. Pour cette raison les auteurs recommandent que, préalablement à la résection de l'uncus ou de l'articulation uncovertébrale, il soit pratiqué une dissection soigneuse de ces structures fibro-ligamentaires.
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Ebraheim, N.A., Lu, J., Haman, S.P. et al. Anatomic basis of the anterior surgery on the cervical spine: Relationships between uncus-artery-root complex and vertebral artery injury. Surg Radiol Anat 20, 389–392 (1998). https://doi.org/10.1007/BF01653127
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DOI: https://doi.org/10.1007/BF01653127