Anatomic basis of the anterior surgery on the cervical spine: relationships between uncus-artery-root complex and vertebral artery injury

Vertebral artery injury is a serious complication during anterior surgery o n the cervical spine. However, little information is available in the liter ature concerning the mechanism of vertebral artery laceration during the pr ocedures of the anterior cervical decompression. In the current study twent y-eight cadavers were dissected to determine the location and relationships of the fibro-ligamentous tissues to the uncinate process, vertebral artery and nerve roots from the C3 to C6 levels. The vertebral artery and nerve r oot are encased by a fibro-ligamentous band at the level of the intertransv erse space. This fibro-ligamentous band is attached to the lateral aspect o f the uncinate process and uncovertebral joint, which combines the vertebra l artery, nerve root and uncinate process to form a complex or unit. The fi bro-ligamentous tissues between the uncovertebral joint and vertebral arter y may explain the propensity to vertebral artery laceration during resectio n of the uncinate process or an osteophyte projecting from the uncovertebra l joint. For this reason, the authors recommend that before resection of th e uncinate process or uncovertebral joint is performed, it is necessary to thoroughly dissect the fibro-ligamentous tissues off the uncinate process.