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.
Similar content being viewed by others
References
Fountas KN, Kapsalaki EZ, Nikolakakos LG et al (2007) Anterior cervical discectomy and fusion associated complications. Spine (Phila Pa 1976) 32(21):2310–2317
Bertalanffy H, Eggert HR (1989) Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 99(1–2):41–50
Bruneau M, Cornelius JF, George B (2006) Microsurgical cervical nerve root decompression by anterolateral approach. Neurosurgery 58(1 Suppl):S108–S113
Rhee JM, Ju KL (2016) Anterior cervical discectomy and fusion. JBJS Essent Surg Tech 6(4):e37
Dohn DF (1966) Anterior interbody fusion for treatment of cervical-disk conditions. JAMA 197(11):897–900
An HS, Vaccaro A, Cotler JM et al (1994) Spinal disorders at the cervicothoracic junction. Spine (Phila Pa 1976) 19(22):2557–2564
Busch G (1978) Anterior fusion for cervical spondylosis. J Neurol 219(2):117–126
Tew JJ, Mayfield FH (1976) Complications of surgery of the anterior cervical spine. Clin Neurosurg 23:424–434
Yasumoto Y, Abe Y, Tsutsumi S et al (2008) [Rare complication of anterior spinal surgery: horner syndrome]. No Shinkei Geka 36(10):911–914
Giombini S, Solero CL (1980) Considerations on 100 anterior cervical discectomies without fusion. Springer, Berlin Heidelberg, pp 302–307
Hankinson HL, Wilson CB (1975) Use of the operating microscope in anterior cervical discectomy without fusion. J Neurosurg 43(4):452–456
Johnston FG, Crockard HA (1995) One-stage internal fixation and anterior fusion in complex cervical spinal disorders. J Neurosurg 82(2):234–238
Saunders RL, Bernini PM, Shirreffs TJ et al (1991) Central corpectomy for cervical spondylotic myelopathy: a consecutive series with long-term follow-up evaluation. J Neurosurg 74(2):163–170
Civelek E, Karasu A, Cansever T et al (2008) Surgical anatomy of the cervical sympathetic trunk during anterolateral approach to cervical spine. Eur Spine J 17(8):991–995
Ebraheim NA, Lu J, Yang H et al (2000) Vulnerability of the sympathetic trunk during the anterior approach to the lower cervical spine. Spine (Phila Pa 1976) 25(13):1603–1606
Yin Z, Yin J, Cai J et al (2015) Neuroanatomy and clinical analysis of the cervical sympathetic trunk and longus colli. J Biomed Res 29(6):501–507
Wei Y, Xiao J, Zou L (2007) Masticator space: CT and MRI of secondary tumor spread. AJR Am J Roentgenol 189(2):488–497
Shan J, Jiang H, Ren D et al (2017) Anatomic relationship between right recurrent laryngeal nerve and cervical fascia and its application significance in anterior cervical spine surgical approach. Spine (Phila Pa 1976) 42(8):E443–E447
Robinson RA (1955) Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223–224
Southwick WO, Robinson RA (1957) Surgical approaches to the vertebral bodies in the cervical and lumbar regions. J Bone Jt Surg Am 39(A3):631–644
Lyons AJ, Mills CC (1998) Anatomical variants of the cervical sympathetic chain to be considered during neck dissection. Br J Oral Maxillofac Surg 36(3):180–182
Gray H (2001) The sympathetic nerves. In: Lewis WH (ed) Anatomy of the human body, 20th edn. Lea and Febiger, Philadelphia, pp 1292–1309
Acknowledgements
We expressed our thanks to the staff of anatomy department in Chengdu Medical College.
Funding
This study was not funded by any individual or organization.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical approval
There was no objection from the institutional ethical committee for the above study.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Chen, M., Tang, H. & Shan, J. Anatomic relationship between the cervical sympathetic trunk and cervical fascia and its application in the anterolateral cervical spine surgical approach. Eur Spine J 30, 425–430 (2021). https://doi.org/10.1007/s00586-020-06621-2
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00586-020-06621-2