The Anatomical Relationship Between the Cervical Nerve Roots, Intervertebral Discs and Bony Cervical Landmark for Posterior Endoscopic Cervical Foraminotomy and Discectomy: A Cadaveric Study

ชื่องานวิจัยภาษาไทย

มหกายวิภาคศาสตร์ระหว่างรากประสาทระดับคอ หมอนรองกระดูกและกระดูกสันหลังระดับคอสำหรับการผ่าตัดด้วยวิธี Endoscopic Cervical Foraminotomy and Discectomy ในอาจารย์ใหญ่นุ่มเสมือนจริง

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การศึกษาระยะตัดกระดูกสันหลังที่ปลอดภัยสำหรับรักษาโรคหมอนรองกระดูกคอกดทับเส้นประสาทในอาจารย์ใหญ่แบบนิ่มเสมือนจริง

ที่มาและความสำคัญ

ศัลยแพทย์ปัจจุบันนิยมผ่าตัดรักษาผู้ป่วยโรคหมอนรองกระดูกคอกดทับเส้นประสาทด้วยวิธี posterior endoscopic cervical foraminotomy หรือ discectomy (PECF หรือ PECD) มากขึ้น ทว่าองค์ความรู้เกี่ยวกับจุดสังเกตทางกายวิภาคเพื่อความปลอดภัยในการผ่าตัดนำกระดูกบางส่วนออกเพื่อลดการกดทับเส้นประสาทยังมีอยู่อย่างจำกัด

Abstract

This study investigates the relationships among specific bony structures of cervical vertebra, termed the “V point,” the dural sac, nerve roots, and intervertebral discs. The aim is to improve surgical outcomes and minimize complications in procedures like posterior endoscopic cervical foraminotomy or discectomy (PECF or PECD) for treating cervical radiculopathy. The research, conducted on 10 soft adult cadavers, measured distances between the V point and key anatomical features to provide practical guidance for surgical procedures.
The findings indicate that a 3-4 mm horizontal removal of bone from the V point is sufficient, a 3-4 mm vertical removal of bone in the upper direction is generally adequate at levels C3/4 to C5/6, and a more extensive bone cut of over 4 mm is recommended for levels C6/7 and C7/T1 for effective exposure and neural decompression. This information is valuable for surgeons offering insights that can enhance the efficiency of posterior endoscopic cervical procedures and lower the risk of complications. Surgeons can use these recommended bone removal guidelines to perform these surgeries more effectively, ultimately improving patient outcomes.

Study Design

Cadaveric anatomical studies.

Objective

This study aims to investigate the anatomical relationship between bony landmark “V point”, dural sac, nerve roots, and intervertebral disc for improving operative outcomes and decreasing post-operative complications in posterior endoscopic cervical foraminotomy or discectomy (PECF or PECD).

Method

10 soft adult cadavers were studied. We measured the distance of the V point to the lateral margin of dural sac, V point to the inferior border of intervertebral disc, and the inferior border of cervical nerve root to the inferior border of intervertebral disc. Then we calculated the mean of distance from V point to the inferior border of cervical nerve root.

Result

The mean distance from the V point to the lateral margin of dural sac from C3/4 to C7/T1 ranged from 3.1 ± 1.38 mm to 3.37 ± 1.46 mm. The mean distances from V point to the inferior border of intervertebral disc from C3/4 to C7/T1 were .19 ± 1.16 mm at C3/4, .45 ± 1.23 mm at C4/5, .43 ± 1.01 at C5/6, −.43 ± 1.86 mm at C6/7 and −1.5 ± 1.2 mm at C7/T1. The mean distance between V point and the inferior border of cervical nerve root from C3/4 to C7/T1 showed all positive value, ranging from .06 ± 1.18 mm to 4.45 ± 2.57 mm, increasing caudally.

Conclusion

In performing PECF or PECD, a 3-4 mm radius of bone removal should be enough for exposure and neural decompression at C3/4 to C5/6. At C6/7 and C7/T1 a more extensive bone cut of more than 4 mm is recommended, especially in cranial direction.

Keywords: cervical, disc herniation, disc, decompression, neck pain, radiculopathy

Citation: Keorochana G, Tantrakansakun C, Suriyonplengsaeng C, et al. The Anatomical Relationship Between the Cervical Nerve Roots, Intervertebral Discs and Bony Cervical Landmark for Posterior Endoscopic Cervical Foraminotomy and Discectomy: A Cadaveric Study. Global Spine Journal. 2023;0(0). doi:10.1177/21925682231217251