• A R Vaccaro, D Ring, G Scuderi, and S R Garfin.
• Department of Orthopaedic Surgery, Jefferson Medical College of Thomas Jefferson University, Philadelphia, Pennsylvania.
• Spine. 1994 Dec 1;19(23):2637-41.

Study DesignThis study analyzed the precise two-dimensional location of the vertebral artery within cervical vertebrae as determined by measurements obtained from axial computed tomographic images of the cervical spine.ObjectiveTo determine the margin of safety necessary to avoid vertebral artery laceration during central decompression and lateral nerve root decompression for cervical spinal stenosis.Summary Of Background DataLaceration of the vertebral artery is a rare but potentially catastrophic complication of anterior decompressive surgery of the cervical spine.MethodsThe mean, standard deviation, and 95% confidence interval of the mean of measurements localizing the vertebral artery within the vertebral body were calculated from 50 transaxial computed tomography images of each of the second through sixth cervical vertebrae.ResultsBoth the mean interforaminal distance (from 25.90 +/- 1.89 mm at C3 to 29.30 +/- 2.70 mm at C6) and the average distance of the posterior border of the foramen transversarium from the ventral border of the spinal canal (from 2.16 +/- 1.18 mm at C3 to 3.53 +/- 1.56 mm at C6) increased from C3 to C6.ConclusionsAccording to our measurements, the risk of vertebral artery laceration is greater at more cephalad vertebrae during lateral extension of central decompressive procedures and lateral nerve root decompression. Because of the variability of these parameters between individuals, accurate individual preoperative localization of the vertebral arteries is recommended.

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