Radiographic evaluation of the reliability of neck anatomic structures as anterior cervical surgical landmarks.

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Radiographic evaluation of the reliability of neck anatomic structures as anterior cervical surgical landmarks.

World Neurosurg. 2017 Apr 03;:

Authors: Liu JM, Du LX, Xiong X, Chen XY, Zhou Y, Long XH, Huang SH, Liu ZL

Abstract
BACKGROUND: Accurate location of the skin incision is helpful to decrease the technical difficulty and save the operative time in anterior cervical spine surgery (ACSS). Spine surgeons usually use the traditional neck anatomic structures (hyoid bone, thyroid cartilage and cricoid cartilage) as landmarks during the surgery. However, the reliability of these landmarks has not been validated in actual practice.
OBJECTIVE: To find out which one is the most accurate landmark for identifying the cervical levels in ACSS.
METHODS: The lateral flexion and extension radiographs of cervical spine in standing position from 30 consecutive patients were obtained from January 2015 to February 2015. The cervical vertebral bodies from C2 to C7 were equally divided into two segments. The cervical segments corresponding to each of the surface landmarks were recorded on the flexion and extension radiographs, respectively. And the displacement of corresponding cervical segments from the flexion to extension radiographs for each landmark was calculated.
RESULTS: Based on the measurement, the mainly corresponding cervical levels for mandibular angle were C2 on both of the flexion and extension films, hyoid bone were reference to C3-4 interspace on flexion film and C3 on extension film, thyroid cartilage corresponded to C5 on both of flexion and extension films, and cricoid cartilage corresponded to C6 on flexion film and C5-6 interspace on extension film, respectively. The ratios of displacing within 2 segments from flexion to extension were 83.3% (25/30) for mandibular angle, 56.7% (17/30) for hyoid bone, 66.7% (20/30) for thyroid cartilage and 56.7% (17/30) for cricoid cartilage, respectively. The mean displacement from flexion to extension films were significant less than 2 cervical segments for mandibular angle, but greater than 2 segments for the other landmarks. Significant differences were found between mandibular angle and the other three landmarks for the displacement from flexion to extension.
CONCLUSIONS: The angle of mandible was found to be the most accurate landmark for identifying the cervical level, which corresponded to C2 and C2-3 disc space. The hyoid bone, thyroid cartilage and cricoid cartilage were not reliable to predict the cervical levels.

PMID: 28385657 [PubMed - as supplied by publisher]

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