Anatomy Atlas and Interpretation of Spine Surgery

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2J.-g. Shi et al.Fig. 1.3 Lateral view of theanatomic relationshipbetween the oral cavityproper, posterior pharyngealwall, and upper cervical spineVertebral arteryC1 nervePosterior arch of the atlasuvulaTongue(saggital section)Posterior ramus of C2nervePosterior pharyngeal wallTransverse processAnterior longitudinal ligamentspinal dorsal ramusCervical sympathetic trunkdeep cervical arteryVertebral arteryBrachial plexusthyrocervical trunkSubclavian artery
1 Surgical Anatomy of Upper Cervical Spine31.3 ExposureSteroid should be used locally in the oropharynx toavoid the airway obstruction caused by postoperativeedema. Meanwhile, the retractors should be adjustedto a suitable position in order to avoid excessive retractionand compression of the soft tissues.Epinephrine and lidocaine are injected into theanterior tubercle of the atlas in order to reduce intraoperativebleeding and stretch the posterior pharyngealwall soft tissues.Make a 3 cm vertical incision in the midline of theanterior tubercle of the atlas, which can be extended tothe C2 or C3 level. Incision is made through the mucosa,superior pharyngeal constrictor muscle, and pharyngobasilarfascia layer by layer until the prevertebral fasciato expose the longus colli muscle and the attachmentsite of anterior longitudinal ligament (Fig. 1.4).The anterior tubercle of the atlas is off-center incases of atlantoaxial joint dislocation. Therefore, inaddition to touching the anterior tubercle, the locationof the surgical incision can be confirmed by observingthe position of uvula and X-ray in order to avoid thedeflective incision resulting in imperfect exposure orinjury of important structures.TonguecephaladanteriorlongitudinalligamentSuperior pharyngeal constrictor muscle: a quadrilateralmuscle that is thinner than the middle and inferiorpharyngeal constrictor muscles. Stylopharyngeus andglossopharyngeal nerve are located between the baseof the superior and the middle pharyngeal constrictormuscles. The retropharyngeal space is adjacent to theprevertebral muscle and prevertebral fascia andbounded by the ascending pharyngeal artery, pharyngealvenous plexus, glossopharyngeal nerve, lingualnerve, styloglossus, middle pharyngeal constrictormuscle, medial pterygoid, stylopharyngeus, and stylohyoidligament. The superior pharyngeal constrictormuscle is innervated by the pharyngeal branch ofascending pharyngeal artery and the tonsillar branchof facial artery. Contraction of the superior pharyngealconstrictor muscle is mainly controlled by the transcranialaccessory nerve and results in the contractionof the upper pharynx (Figs. 1.5 and 1.26).Subperiosteal dissection is performed along the midline.The anterior arch of the atlas and the atlantoaxialjoint are exposed by distracting the longus colli musclelaterally (Fig. 1.6).Exposure of the atlas and axis should be maintainedwithin 15 mm in width to protect the superior cervicalganglion from injury. Artery location should be confirmedby preoperative imaging to prevent injuries tothe vertebral artery and internal carotid artery.Fig. 1.4 Incision of the posterior pharyngeal wall and exposure of theprevertebral fascia
Page 1 and 2: Anatomy Atlasand Interpretationof S
Page 3 and 4: Jian-gang Shi • Wen Yuan • Jing
Page 5 and 6: Foreword I for Chinese VersionScien
Page 7 and 8: Foreword II for English VersionWith
Page 9 and 10: xPreface for English EditionWe sinc
Page 11 and 12: Contents1 Surgical Anatomy of Upper
Page 13 and 14: xviList of Editors and Contributors
Page 15: Surgical Anatomy of UpperCervical S
Page 19 and 20: 1 Surgical Anatomy of Upper Cervica
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1 Surgical Anatomy of Upper Cervica
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Surgical Anatomy of the SubaxialCer
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2 Surgical Anatomy of the Subaxial
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Surgical Anatomy of the Thoracic Sp
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3 Surgical Anatomy of the Thoracic
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Surgical Anatomy of the Lumbar Spin
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4 Surgical Anatomy of the Lumbar Sp
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2841.3 ExposureMake a midline incis
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286J.-g. Shi et al.Fig. 5.8 Intraop
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288J.-g. Shi et al.Fig. 5.12 Antero
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290J.-g. Shi et al.Femoral nerve: t
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292J.-g. Shi et al.Fig. 5.19 Nerves
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Anatomy Atlas and Interpretation of Spine Surgery

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