Anatomical projection of the cervical uncinate process in ventral, ventrolateral, and posterior decompressive surgery

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Object. The cervical uncinate processes (UPs), their variations, and the relationships between the neurovascular structures and surrounding bone were investigated in this anatomical study. The object of this study was to highlight the important surgery-related considerations associated with ventral, ventrolateral, and posterior decompressive surgery.

Methods. Forty-nine adult C3–7 dry bone samples were used, and 10 measurements were obtained for each vertebra. The anterior measurements involved the cervical uncinate process (UP): height, width, length, distance between its tip and vertebral foramina, interuncinate process distance, sagittal angle with the superior margin of the vertebral body (VB), VB anteroposterior diameter, and VB width. Posterior measurements involved the vertical distance between the superior border of the lamina at the lamina—facet joint and the tip of the UP, as well as the horizontal distance between the medial-most border of the superior facet and the tip of the UP. All symmetrical structures were measured bilaterally. There were no statistically significant differences between right- and left-sided measurements in this series.

The height of the UP increased gradually at each segmental level between C-3 and C-7. The width of the UP did not change with segmental level (5.0 mm at C-3 compared with 5.3 mm at C-7). On average, the length of the UP was relatively constant. The distance from the tip of the UP to vertebral foramina averaged 1 mm at the C2–3 level and 1.5 mm at the C5–6 level. Interuncinate distance and VB width gradually increased and were highly variable, which appeared to be related with osteophyte formation. There was a slight gradual increase from C-3 to lower segments, and it paralleled with the midline anteroposterior diameter of the same VB. The angle between the UP and the superior margin of the VB exhibited great variety. The posterior measurements decreased gradually from C-3 to C-7.

Conclusions. Based on the data obtained in this study, a surgeon is provided with a three-dimensional orientation as well as anatomical knowledge. This knowledge also allows for a more effective neurovascular decompression by minimizing the surgery-related complications.

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Contributor Notes

Address reprint requests to: Ayhan Attar, M.D., Ankara Universitesi Tip Fakultesi, Ibn-i Sina Hastenesi, Norosirurji Bolumu, 06100 Sihhiye, Ankara, Turkey. email: ayhanattar@hotmail.com.

© AANS, except where prohibited by US copyright law.

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References
  • 1.

    Clausen JGoel VKTraynelis VCet al: Uncinate processes and Luschka joints influence the biomechanics of the cervical spine: quantification using a finite element model of the C5–C6 segment. J Orthop Res 15:3423471997Clausen J Goel VK Traynelis VC et al: Uncinate processes and Luschka joints influence the biomechanics of the cervical spine: quantification using a finite element model of the C5–C6 segment. J Orthop Res 15:342–347 1997

    • Search Google Scholar
    • Export Citation
  • 2.

    Cloward RB: The anterior approach for removal of ruptured cervical disc. J Neurosurg 15:6026141958Cloward RB: The anterior approach for removal of ruptured cervical disc. J Neurosurg 15:602–614 1958

    • Search Google Scholar
    • Export Citation
  • 3.

    Cusick JFYoganandan NPintar Fet al: Biomechanics of cervical spine facetectomy and fixation techniques. Spine 13:8088121988Cusick JF Yoganandan N Pintar F et al: Biomechanics of cervical spine facetectomy and fixation techniques. Spine 13:808–812 1988

    • Search Google Scholar
    • Export Citation
  • 4.

    Ebraheim NAXu RBhatti RAet al: The projection of the cervical disc and uncinate process on the posterior aspect of the cervical spine. Surg Neurol 51:3633671999Ebraheim NA Xu R Bhatti RA et al: The projection of the cervical disc and uncinate process on the posterior aspect of the cervical spine. Surg Neurol 51:363–367 1999

    • Search Google Scholar
    • Export Citation
  • 5.

    Golfinos JGDickman CAZabramski JMet al: Repair of vertebral artery injury during anterior cervical decompression. Spine 19:255225561994Golfinos JG Dickman CA Zabramski JM et al: Repair of vertebral artery injury during anterior cervical decompression. Spine 19:2552–2556 1994

    • Search Google Scholar
    • Export Citation
  • 6.

    Hakuba A: Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg 45:2842911976Hakuba A: Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg 45:284–291 1976

    • Search Google Scholar
    • Export Citation
  • 7.

    Henderson CHennessy RShuey Het al: Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery 13:5045121983Henderson C Hennessy R Shuey H et al: Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery 13:504–512 1983

    • Search Google Scholar
    • Export Citation
  • 8.

    Herkowitz HNKurz LTOverholt DP: Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine 15:102610301990Herkowitz HN Kurz LT Overholt DP: Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine 15:1026–1030 1990

    • Search Google Scholar
    • Export Citation
  • 9.

    Jho HD: Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg 84:1551601996Jho HD: Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg 84:155–160 1996

    • Search Google Scholar
    • Export Citation
  • 10.

    Leosin FBiondi AJomin M: Foraminal cervical herniated disc treated by anterior discoforaminotomy. Neurosurgery 21:3343381987Leosin F Biondi A Jomin M: Foraminal cervical herniated disc treated by anterior discoforaminotomy. Neurosurgery 21:334–338 1987

    • Search Google Scholar
    • Export Citation
  • 11.

    Lu JEbraheim NAYang Het al: Cervical uncinate process: an anatomic study for anterior decompression of the cervical spine. Surg Radiol Anat 20:2492521998Lu J Ebraheim NA Yang H et al: Cervical uncinate process: an anatomic study for anterior decompression of the cervical spine. Surg Radiol Anat 20:249–252 1998

    • Search Google Scholar
    • Export Citation
  • 12.

    Manabe STateishi AOhno T: Anterolateral uncoforaminotomy for cervical spondylotic myeloradiculopathy. Acta Orthop Scand 59:6696741988Manabe S Tateishi A Ohno T: Anterolateral uncoforaminotomy for cervical spondylotic myeloradiculopathy. Acta Orthop Scand 59:669–674 1988

    • Search Google Scholar
    • Export Citation
  • 13.

    Mixter WJBarr SJ: Rupture of intervertebral disc with involvement of the spinal canal. N Engl J Med 211:2102151934Mixter WJ Barr SJ: Rupture of intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210–215 1934

    • Search Google Scholar
    • Export Citation
  • 14.

    Pait TGKillefer JAArnautovic KI: Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures. Neurosurgery 39:7697761996Pait TG Killefer JA Arnautovic KI: Surgical anatomy of the anterior cervical spine: the disc space vertebral artery and associated bony structures. Neurosurgery 39:769–776 1996

    • Search Google Scholar
    • Export Citation
  • 15.

    Panjabi MMDuranceau JGoel Vet al: Cervical human vertebrae: quantitative three-dimensional anatomy of the middle and lower regions. Spine 16:8618691991Panjabi MM Duranceau J Goel V et al: Cervical human vertebrae: quantitative three-dimensional anatomy of the middle and lower regions. Spine 16:861–869 1991

    • Search Google Scholar
    • Export Citation
  • 16.

    Payne EESpillane JD: The cervical spine: An anatomicopathological study of 70 specimens (using a special technique) with particular reference to the problem of cervical spondylosis. Brain 80:5715971957Payne EE Spillane JD: The cervical spine: An anatomicopathological study of 70 specimens (using a special technique) with particular reference to the problem of cervical spondylosis. Brain 80:571–597 1957

    • Search Google Scholar
    • Export Citation
  • 17.

    Rabinson RASmith JW: Anterolateral cervical disc removal and interbody fusion the cervical disc syndrome. Bull Johns Hopkins Hosp 96:2232241995Rabinson RA Smith JW: Anterolateral cervical disc removal and interbody fusion the cervical disc syndrome. Bull Johns Hopkins Hosp 96:223–224 1995

    • Search Google Scholar
    • Export Citation
  • 18.

    Smith MDEmery SEDudley Aet al: Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. J Bone Joint Surg (Br) 75:4104151993Smith MD Emery SE Dudley A et al: Vertebral artery injury during anterior decompression of the cervical spine. A retrospective review of ten patients. J Bone Joint Surg (Br) 75:410–415 1993

    • Search Google Scholar
    • Export Citation
  • 19.

    Verbiest H: A lateral approach to the cervical spine: technique and indications. J Neurosurg 28:1912031968Verbiest H: A lateral approach to the cervical spine: technique and indications. J Neurosurg 28:191–203 1968

    • Search Google Scholar
    • Export Citation
  • 20.

    Zdeblick TAZou DWarden KEet al: Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am) 74:22271992Zdeblick TA Zou D Warden KE et al: Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am) 74:22–27 1992

    • Search Google Scholar
    • Export Citation
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