245 - Prevertebral Vascular and Esophageal Consideration during Percutaneous...

#245 Prevertebral Vascular and Esophageal Consideration during Percutaneous Cervical Disc Procedures

Non-operative Care and Injection Therapies

Poster Presented by: J.K. Jeon

Author(s):

J.K. Jeon (1,2)
C.H. Oh (1,2)
S.H. Choi (1)
G.Y. Ji (3)

(1) Guro Teun Teun Hospital, Neurosurgery, Seoul, Korea, Republic of
(2) Spine and Joint Research Institute, Guro Teun Teun Hospital, Seoul, Korea, Republic of
(3) Yonsei University College of Medicine, Neurosurgery, Seoul, Korea, Republic of

Abstract

Study Design: A retrospective review series.

Objective: To identify vascular anatomy and esophageal deviation which can interfere percutaneous anterior approach in cervical spine surgery.Summary of Background Data: Percutaneous anterior approach has been used for minimally invasive interventions of cervical disc diseases. Although percutaneous anterior approach has been frequently performed, reports about anatomical structures and procedural risks are limited.

Methods: A total of 511 cases of cervical magnetic resolution (MR) images from December 2012 to April 2013 in our institution were enrolled in this study. The mean age of these patients was 45.7 years old, ranging from 17 to 87 years old. Each axial T2 weighted MR images from C3/4 to C6/7 disc level (total 3066 images) were reviewed to check the presence of small vessels in left and right side trajectory of percutaneous cervical procedures. Esophageal deviation was also measured at the level of C6/7.

Results: The prevalence of small vessels in anterior neck was observed, respectively, 50.5% (in left side trajectory) and 49.1% (in right side trajectory) in C3/4 disc level, 30.3% (left) and 28.8% (right) in C4/5 disc level, 24.1% (left) and 7.6% (right) in C5/6 disc level, and 55.2% (left) and 43.1% (right) in C6/7 disc level. Small vessels were not differently observed in upper cervical level (C3/4/5), but less frequently observed at right side in lower cervical level (C5/6/7). Esophageal deviation was also differently observed with less deviated to right side (0.63 • 0.35 cm) than left side (1.18 • 0.52 cm). Indeed, the esophageal diverticulum was also observed in 1 case at left side.

Conclusion: Careful review of cervical MRI is essential to prevent complications after percutaneous cervical procedures. Although major concern about surgical approach is the location of pathology which we want to remove, but, right side approach seems to be preferred to avoid small vessels and esophageal injury.

Keywords: Percutaneous procedure, cervical spine, complication, vessel, esophageal deviation.