What structure is at risk with lateral dissection of the atlas

The vertebral artery lies lateral to the ring of the atlas (Fig. 25-2); therefore, the dissection should not be carried more than 1.5 cm lateral to the posterior midline and 8 to 10 mm laterally along the superior C1 border to avoid injury to the vertebral artery. Once the greater occipital nerve is encountered and the fragile venae comitantes of the paravertebral venous plexus are exposed, further lateral dissection endangers the vertebral artery. If bleeding is encountered from disruption of the venous plexus between C1 and C2, packing and hemostatic agents are usually adequate to control bleeding. If vertebral artery injury occurs, direct repair, manual pressure, and ligation are options for control of hemorrhage.

Figure 25-1. Ligamentum nuchae. (From Winter R, Lonstein J, Denis F, et al. Posterior upper cervical procedures: Atlas of Spinal Surgery. Philadelphia: Saunders; 1995. p. 21.)
How To Win Your War Against Back Pain

How To Win Your War Against Back Pain

Knowing the causes of back pain is winning half the battle against it. The 127-page eBook, How To Win Your War Against Back Pain, explains the various causes of back pain in a simple manner and teaches you the various treatment options available. The book is a great pain reliever in itself. The sensible, practical tips that it presents will surely help you bid good-bye to back pain forever.

Get My Free Ebook

Post a comment