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Prevertebral Vascular and Esophageal Consideration During Percutaneous Cervical Disc Procedures

Jeon, Jae Kyun MD*; Oh, Chang Hyun MD*; Chung, Daeyeong MD; Lee, Junho MD*; Choi, Seung Hyun MD*; Choi, Eunhwa MD; Ji, Gyu Yeul MD§

doi: 10.1097/BRS.0000000000000140
Cervical Spine

Study Design. A retrospective review series.

Objective. To identify vascular anatomy and esophageal deviations that may interfere with a percutaneous anterior approach in cervical spine surgery.

Summary of Background Data. The percutaneous anterior approach has been used for minimally invasive interventions of cervical disc diseases. Although the percutaneous anterior approach is frequently performed, reports of obstructing anatomical structures and procedural risks are limited.

Methods. Cervical magnetic resonance images obtained from December 2012 to April 2013 from a total of 511 patients at Guro Teun Teun Hospital were evaluated in this study. Each axial T2-weighted MR image from the disc levels of C3–C4 to C6–C7 (total, 3066 images) was reviewed to check for the presence of small vessels along the trajectories of percutaneous cervical procedures on the left and right sides. Esophageal deviation was also measured at level C6–C7.

Results. Small vessels in the anterior neck were present, respectively, in 50.5% (trajectory on the left side) and in 49.1% (trajectory on the right side) at disc level C3–C4, in 30.3% and 28.8% at C4–C5, in 24.1% and 7.6% at C5–C6, and in 55.2% and 43.1% at C6–C7. There were no differences in the number of small vessels between the left and right sides at the upper cervical level (C3–C4–C5), but small vessels were less frequently observed on the right side at lower cervical levels (C5–C6–C7). Differences in esophageal deviation were also observed, with less deviation to the right side (0.63 ± 0.35 cm) than the left (1.18 ± 0.52 cm). As well, an esophageal diverticulum was observed in 1 case on the left side.

Conclusion. Although surgical approaches are mostly concerned with the location of pathology to be removed, a right-sided percutaneous approach seems preferable because poses less of a risk of encountering small vessels and causing esophageal injury.

Level of Evidence: 4

Significantly fewer vascular structures in the prevertebral areas of C5–C6 and C6–C7 were found on the right side, whereas esophageal deviation was predominant to the left side. A right-sided percutaneous approach seems preferable because it poses less of a risk of encountering small vessels and causing esophageal injury.

*Department of Neurosurgery, Spine and Joint Research Institute, Guro Teun Teun Hospital, Seoul, Korea

Department of Neurosurgery, Daegu Teun Teun Hospital, Daegu, Korea

Department of Diagnostic Radiology, Guro Teun Teun Hospital, Seoul, Korea; and

§Department of Neurosurgery, Spine and Spinal Cord Research Institute, Yonsei University, College of Medicine, Seoul, Korea.

Address correspondence and reprint requests to Gyu Yeul Ji, MD, Department of Neurosurgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, Korea; E-mail:

Acknowledgment date: August 13, 2013. Revision date: November 6, 2013. Acceptance date: November 11, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

The Teun Teun Research Foundation funds were received in support of this work.

No relevant financial activities outside the submitted work.

Jae Kyun Jeon and Chang Hyun Oh contributed equally to this project and are considered as co-first authors.

© 2014 by Lippincott Williams & Wilkins