Anatomic relationship between the cervical sympathetic trunk and cervical fascia and its application in the anterolatera
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ORIGINAL ARTICLE
Anatomic relationship between the cervical sympathetic trunk and cervical fascia and its application in the anterolateral cervical spine surgical approach Mengmeng Chen1 · Hai Tang1 · Jianlin Shan1 Received: 4 January 2020 / Revised: 3 September 2020 / Accepted: 29 September 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Objectives To understand the anatomical relationship between the cervical sympathetic trunk (CST) and the cervical fascia and to provide a more reliable method for avoiding CST injury during the anterolateral cervical spine surgical approach. Methods Forty-two formalin-fixed adult cadaver specimens were divided into two groups. In the first group, the distance from the inner edge of the bilateral CSTs to the medial border of the longus colli muscle (LCM) and the distance between the CST and the midline of the cervical vertebrae were measured from the middle of the C3 vertebra through the C7 vertebra. The positional relationship between the CST and the superficial layer of the prevertebral fascia (alar fascia) was observed. In the second group, the carotid sheath and its contents were cut horizontally to observe the relationship between the CST and the carotid sheath. Results In the first group, the CST gradually converged medially and was closest to the medial border of the LCM at the level of the C7 vertebra. The distance from the CST to the vertebral midline was the smallest at the level of the C7 vertebra. In all specimens, the CST was closely adhered behind the alar fascia above the C7 vertebra and therefore could not be easily separated from the alar fascia by blunt dissection. In the second group, the CST in all specimens was tightly adhered behind the carotid sheath. Conclusion The CST was tightly adhered to the alar fascia and could be naturally retracted with the alar fascia. Retracting the alar fascia can effectively protect the CST. Keywords Alar fascia · Cervical sympathetic trunk · Carotid sheath · Surgical approach
Introduction The anterolateral approach to the subaxial cervical spine is widely used in the treatment of degenerative cervical spine disease, tumors, trauma and infections. Cervical sympathetic trunk (CST) injury is a complication of this approach with a reported incidence rate varying from 0.1 to 4% [1–13]. In the literature, anatomical studies conducted to prevent CST injury in the anterolateral cervical spine surgical approach have focused on measuring the distance from the CST to the medial border of the longus colli muscle (LCM) and the * Jianlin Shan [email protected] 1
Department of Orthopaedics, Beijing Friendship Hospital, Capital Medical University, No. 95, Yong An Road, XiCheng District, Beijing 100050, People’s Republic of China
vertebral centerline to determine the safe operating range during surgery [14–16]. The results of these studies have indicated that the range between the bilateral sympathetic nerves is sufficient for surgeries of ordinary cervical degeneration diseases, including cervical disc
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