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Cervical Facet Joint Interventions
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Laxmaiah Manchikanti, David M. Schultz, Vijay Singh
Overall, the posterior approach is considered safer because the needle penetrates only the skin and posterior neck muscles, with the deep cervical artery the only structure at risk of inadvertent puncture. Further, the posterior cervical artery poses minimal risk of morbidity, as it supplies no major structures. However, if the needle is inserted too deeply or too aggressively, it could penetrate the anterior joint capsule. Further, the risk is not only leakage of local anesthetic and steroid over to the dorsal root ganglion, but also the risk of puncture to the vertebral artery or ventral ramus of the spinal nerve lying in front of the joint. In addition, the needle may also enter the epidural space or spinal cord.
Head and Neck
Published in Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno, Understanding Human Anatomy and Pathology, 2018
Rui Diogo, Drew M. Noden, Christopher M. Smith, Julia Molnar, Julia C. Boughner, Claudia Barrocas, Joana Bruno
In adult humans, the subclavian artery is one of the two structures (together with the roots of the branchial plexus) deep to the anterior scalene muscle, contrary to the subclavian vein, which is one of the major four structures superficial to this muscle together with the phrenic nerve, suprascapular artery, and transverse cervical artery (the anterior scalene muscle is a major landmark in the neck and follows the “4 superficial vs. 2 deep” rule: See Box 3.10). Because these two latter arteries are branches of the subclavian artery (which is deep to the anterior scalene muscle), they must run superficially and appear anteriorly to the anterior scalene muscle and run posteriorly and superficially to it (Plate 3.22). The 1st, 2nd, and 3rd parts of the subclavian artery are medial, posterior, and lateral to the anterior scalene muscle, respectively. The 1st part has three branches: (1) the vertebral artery running superiorly between the anterior scalene muscle and the longus colli muscle and entering the transverse foramen of vertebra C6; (2) the internal thoracic artery running inferiorly to supply the anterior thoracic wall; and (3) the thyrocervical trunk giving rise to the suprascapular artery (described in Chapter 4) and transverse cervical artery (which supplies the trapezius muscle) described earlier, and to the inferior thyroid artery, which passes posterior to the cervical sympathetic trunk toward the thyroid gland and gives rise to the ascending cervical artery. The 2nd part of the subclavian artery has one branch: the costocervical trunk, which gives rise to the deep cervical artery and the supreme intercostal artery (which gives rise to the posterior intercostal arteries 1 and 2). Lastly, the third part of the subclavian artery gives off a single branch—the dorsal scapular artery—before changing its name to the axillary artery at the level of the 1st rib (both the dorsal scapular and the axillary arteries are described in Chapter 4). It should be noted that the thoracic duct lies in this region of the root of the neck, draining into the junction of the left subclavian vein and the left internal jugular vein.
Endovascular treatment with tirofiban during the acute stage of cervical spinal cord infarction due to vertebral artery dissection
Published in The Journal of Spinal Cord Medicine, 2020
Yuanling Wu, Wenxian Li, Xiaomei Xie, Zhen Jing, Weibiao Lu, Li’an Huang
The segmental spinal arteries supplying the cervical region vary considerably between individuals because these arteries generally originate from the vertebral or subclavian artery.6 ASA is formed by the confluence of the bilateral vertebral artery branches and descends to the conus medullaris. ASA is a series of anastomotic vascular loops, not a single artery, and thus requires a segmental radiculomedullary arterial supply to provide adequate blood flow to the anterior two-thirds of the spinal cord tissue.7 Radiculomedullary arteries at the cervical segment often originate from a deep cervical artery or vertebral arteries. The mechanism of dissection is associated with intimal tears of arteries followed by hemodynamic-relevant stenosis and secondary thrombosis, which results in acute ischemic stroke and progressive symptoms.3 The dissection in our patient occurred at the left V2 segment and resulted in stenosis of the lumen and hemodynamic changes. There was insufficient time for contralateral vertebral or subclavian artery compensation; the left radiculomedullary arteries were suddenly disrupted, and the cervical segment of ASA was insufficient. The cervical spinal cord infarction formed over time (Fig. 2A and B). Moreover, the patient presented with a progressing stroke due to secondary microemboli induced by dissection, which preceded the neurological deficit. Timely and effective therapy was necessary.