Abstract
The sympathetic trunk is sometimes damaged during the anterior and anterolateral approach to the cervical spine, resulting in Horner’s syndrome. No quantitative regional anatomy in fresh human cadavers describing the course and location of the cervical sympathetic trunk (CST) and its relation to the longus colli muscle (LCM) is available in the literature. The aims of this study are to clearly delineate the surgical anatomy and the anatomical variations of CST with respect to the structures around it and to develop a safer surgical method that will diminish the potential risk of CST injury. In this study, 30 cadavers from the Department of Forensic Medicine were dissected to observe the surgical anatomy of the CST. The cadavers used in this study were fresh cadavers chosen at 12–24 h postmortem. The levels of superior and intermediate ganglions of cervical sympathetic chain were determined. The distance of the sympathetic trunk from the medial border of LCM at C6, the diameter of the CST at C6 and the length and width of the superior and intermediate (middle) cervical ganglion were measured. Cervical sympathetic chain is located posteromedial to carotid sheath and just anterior to the longus muscles. It extends longitudinally from the longus capitis to the longus colli over the muscles and under the prevertebral fascia. The average distance between the CST and medial border of the LCM at C6 is 11.6 ± 1.6 mm. The average diameter of the CST at C6 is 3.3 ± 0.6 mm. Superior ganglion of CSC in all dissections was located at the level of C4 vertebra. The length and width of the superior cervical ganglion were 12.5 ± 1.5 and 5.3 ± 0.6 mm, respectively. The location of the intermediate (middle) ganglion of CST showed some variations. The length and width of the middle cervical ganglion were 10.5 ± 1.3 and 6.3 ± 0.6 mm, respectively. The CST’s are at high risk when the LC muscle is cut transversely, or when dissection of the prevertebral fascia is performed. Awareness of the CST’s regional anatomy may help the surgeon to identify and preserve it during anterior cervical surgeries.
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References
An HS, Vaccaro A, Cotler JM, Lin S (1994) Spinal disorders at the cervicothoracic junction. Spine 19:2557–2564
Bertalanffy H, Eggert HR (1989) Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 99:41–50
Cuatico W (1981) Anterior cervical discectomy without interbody fusion: an analysis of 81 cases. Acta Neurochir (Wien) 57:269–274
Dohn DF (1966) Anterior interbody fusion for treatment of cervical disc conditions. JAMA 197:897–900
Ebraheim NA, Lu J, Yang H, Heck BE, Yeasting RA (2000) Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine. Spine 25:1603–1606
George B, Lot G (1994) Oblique transcorporeal drilling to treat anterior compression of the spinal cord at the cervical level. Minim Invas Neurosurg 37:48–52
Giombini S, Solero CL (1980) Considerations on 100 anterior cervical discectomies without fusion. In: Grote W, Brock M, Clar HE, Klinger M, Nau HE (eds) Advances in neurosurgery, vol 8. Springer, Berlin, pp 302–307
Hankinson HL, Wilson CB (1975) Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg 43:452–456
Johnston FG, Crockard A (1995) One-stage internal fixation and anterior fusion in complex cervical spinal disorders. J Neurosurg 82:234–238
Katritsis ED, Lykaki-Anastopoulou G, Papadopoulos NJ (1983) Anatomical observations on the intermediate ganglion of the cervical sympathetic trunk. Anat Anz 154:33–38
Kıray A, Arman C, Naderi S, Guvencer M, Korman E (2005) Surgical anatomy of the cervical sympathetic trunk. Clin Anat 18:179–185
Kiris T (2002) Anterolateral surgical approach in cervical spondilotic myelopathy and surgery of spinal column. In: Zileli M, Ozer AF (eds) Omurilik ve omurga cerrahisi, Cilt 1. Meta Basim Matbaacilik Hizmetler Publishing, Bornova, pp 605–623 (Turkish)
Lyons AJ, Mills CC (1998) Anatomical variants of the cervical sympathetic chain to be considered during neck dissection. Br J Oral Maxillofac Surg 36:180–182
Pait TG, Killefer JA, Arnautovic KI (1996) Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures. Neurosurgery 39(4):769–776
Saunders RL, Bernini PM, Shirreffs TG et al (1991) Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74:163–170
Smith GW, Robinson RA (1958) The treatment of cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg [Am] 40:607–624
Tanaka N, Fujimoto Y, Howard A, Ikuta Y, Yasuda M (2000) The Anatomic relation among the nerve roots, intervertebral foramina, and intervertebral discs of the cervical spine. Spine 25(3):286–291
Tew JM, Mayfield FH (1976) Complications of surgery of the anterior cervical spine. Clin Neurosurg 23:424–434
Tubbs RS, Salter EG, Oakes WJ (2005) Anatomic landmarks for nerves of the neck: a Vade Mecum for neurosurgeons. Oper Neurosurg 2(56):256–260
Williams PL, Bannister LH, Berry MM, Collins P, Dyson M, Dussek JE, Ferguson MWJ (1995) Gray’s Anatomy, 38th edn. Churchill Livingstone, London, pp 1298–1312
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Civelek, E., Karasu, A., Cansever, T. et al. Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine. Eur Spine J 17, 991–995 (2008). https://doi.org/10.1007/s00586-008-0696-8
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DOI: https://doi.org/10.1007/s00586-008-0696-8