Vulnerability of vertebral artery in anterolateral decompression for cervical spondylosis

Abstract

This study aimed to provide anatomic data for the location of the vertebral artery and offer an optimal approach for lateral cervical decompression that minimizes the risk of injury to the vertebral artery. Anatomically, there has been little study documenting the safe zone to prevent vertebral artery injury during the resection of the uncinate process or uncovertebral joint during the lateral decompression of the nerve root. The transverse foramen and its related parameters were measured on dry cervical spines from C3 to C7. The cadaveric cervical spines were dissected to determine a method for resection of the uncovertebral joint with decreased risk of vertebral artery laceration. The anteroposterior diameters of the transverse foramina gradually decreased from C6 to C3. The transverse diameters of the transverse foramina were smaller at C5. The interforaminal distance, width of the vertebrae, interuncinate distance, and the distance from the lateral tip of the uncinate process to the medial border of the transverse foramen became smaller in more cephalad vertebrae. After subtotal vertebrectomy and opening of the anterior walls of the transverse foramina, the resection of the uncovertebral joint and lateral decompression became easier and safer. Anatomic measurements obtained in this study indicate the vertebral artery to be at risk during decompression of the more cephalad vertebrae. The lateral decompression can be completed under direct vision with smaller rongeurs and curettes, rather than with high speed burr after deroofing the anterior walls of transverse foramina and retracting the vertebral artery laterally.