Posterior Exposure of the Vertebral Artery in the Subaxial Cervical Spine: A Cadaveric Study

Abstract

Vertebral artery anomalies and anatomic variations noted from cadaveric dissections and imaging studies are well documented within the literature at the craniovertebral junction as well as subaxial cervical spine. Such abnormalities can lead to Vertebral artery injuries causing a myriad of comorbidities for patients. In such situations, Vertebral artery may need to be repaired especially if the dominant artery was injured. In this study, we describe a safe surgical approach to expose the Vertebral artery in the subaxial cervical spine using 6 formalin fixed cadavers to assess the feasibility of our approach. Neural foraminal decompression was performed to identify the nerve roots followed by complete resection of the inferior and superior articular processes at the intended levels. The pedicle was skeletonized, and the posterior wall of the transverse foramen was removed. The Vertebral artery could then be exposed between the two nerve roots. Multiple measurements were reported to guide the approach, including the Vertebral artery diameter between the nerve roots on the left and right side from C3-C7, the distance from midline to the medial edge of the Vertebral artery, and the distance from midline to the lateral edge of the Vertebral artery. To our knowledge, this is the first study describing a safe approach to expose the subaxial Vertebral artery.