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Feasibility of total and partial uncinectomy during anterior cervical approach: MRI-based analysis of 176 patients regarding vertebral artery location

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Abstract

Purpose

To determine the technical feasibility of uncinate process (UP) resection (uncinectomy) during anterior cervical approach with risk-avoidance of vertebral artery (VA) injury.

Methods

One hundred and seventy-six magnetic resonance imaging images with cervical spondylosis were evaluated. The diameter between UP and VA (UP–VA distance), the presence of a fat plane, and the VA's anterior–posterior position relative to UP (anterior[A], middle[M], posterior[P]) at C3-4 to C6-7 segments were investigated. Subsequently, easy-to-use classifications were developed according to the feasibility of total and partial uncinectomy. Total uncinectomy: easy (distance: > 2 mm); moderate (distance: ≤ 2 and fat plane: +); advanced (no fat plane). Partial uncinectomy: easy (distance: > 2 mm and P, A, or M position); moderate (distance: ≤ 2; fat plane: + and P position), and advanced (no fat plane and P position).

Results

UP-VA distance of C5-6 on the right side (left/right: 0.41/0.31 mm) was the smallest. The ratio of no fat plane of C5-6 (46.6%/49.4%) was the highest. C5-6 had a high rate of P position (7.4%/8.5%) while C6-7 had a high rate of A position (19.3%/18.2%). More than 90% individuals were classified as easy for partial uncinectomy at any vertebral segment (C3-7), while more than 30% were classified as advanced at C4-7 with the highest rate at C5-6 for total uncinectomy.

Conclusion

When performing uncinectomy during the anterior cervical approach, the C5-6 segment may be at the greatest risk of VA injury. Hence, preoperative MR images should be thoroughly evaluated to avoid VA injury.

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Acknowledgements

We appreciate the English proofreading of this manuscript by Editage (www.editage.com).

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Shogoin, Kawahara-Cho 54, Sakyo-Ku, Kyoto, 606-8507, Japan

    Koichiro Shima, Takayoshi Shimizu, Shunsuke Fujibayashi, Koichi Murata, Shuichi Matsuda & Bungo Otsuki

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  1. Koichiro Shima
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  2. Takayoshi Shimizu
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  3. Shunsuke Fujibayashi
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Correspondence to Koichiro Shima.

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This study was approved by the institutional ethics committee (R2901).

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Shima, K., Shimizu, T., Fujibayashi, S. et al. Feasibility of total and partial uncinectomy during anterior cervical approach: MRI-based analysis of 176 patients regarding vertebral artery location. Eur Spine J 32, 3540–3546 (2023). https://doi.org/10.1007/s00586-023-07888-x

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  • DOI: https://doi.org/10.1007/s00586-023-07888-x

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