{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,30]],"date-time":"2026-06-30T09:31:31Z","timestamp":1782811891100,"version":"3.54.5"},"reference-count":12,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["SPI"],"published-print":{"date-parts":[[2006,11]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>During surgical procedures focused on the cervical nerve roots, the surgeon works in proximity to the V<jats:sub>2<\/jats:sub> segment of the vertebral artery (VA). Depending on the specific surgical approach, it may be necessary to identify, expose, or mobilize the artery. In most cases, the artery may be left undisturbed. To reduce the risk of iatrogenic injury to the V<jats:sub>2<\/jats:sub> segment during anterior and anterolateral approaches to the cervical spine, the authors analyzed the relationship between the V<jats:sub>2<\/jats:sub> segment and the proximal segment of the C3\u20136 nerve roots.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Six cadaveric cervical spines (12 sides) were fixed with formalin, injected with red and blue latex, and investigated intraoperatively using different magnifications (\u00d7 3\u201340).<\/jats:p>\n<jats:p>The VA rested on the anteromedial surface of the cervical nerve roots at the level of each intertransverse space. The exiting nerve roots intersected the VA at a distance ranging from 4.5 to 8.1 mm (mean 6.3 \u00b1 1.06 mm) from the dural sac. The distance was slightly shorter at cephalad levels, suggesting that the artery is more posteriorly and medially situated at those levels. Arterial pedicles anchored the VA to the cervical nerve roots at various levels. These arteries gave rise to purely radicular, ligamentous, and medullary branches without a predictable pattern. After reaching the nerve roots on their lower margin, the nonligamentous branches pierced the radicular dural sheath within the neural foramen at a distance of 2 to 4 mm from the VA.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Proximal-to-distal dissection of a cervical nerve root may proceed with relative safety for at least 4 mm. The V<jats:sub>2<\/jats:sub> segment of the VA gives rise to at least one radicular arterial pedicle between C-4 and C-6. These trunks give rise to purely radicular, ligamentous, and medullary branches in an unpredictable pattern.<\/jats:p><\/jats:sec>","DOI":"10.3171\/spi.2006.5.5.440","type":"journal-article","created":{"date-parts":[[2008,1,24]],"date-time":"2008-01-24T12:21:52Z","timestamp":1201177312000},"page":"440-442","source":"Crossref","is-referenced-by-count":13,"title":["Anatomical relationships between the V2 segment of the vertebral artery and the cervical nerve roots"],"prefix":"10.3171","volume":"5","author":[{"given":"Sergio","family":"Paolini","sequence":"first","affiliation":[{"name":"Universit\u00e0 degli Studi di Perugia, IRCCS Neuromed, Pozzilli, Italy; and Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine at Peoria, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Lanzino","sequence":"additional","affiliation":[{"name":"Universit\u00e0 degli Studi di Perugia, IRCCS Neuromed, Pozzilli, Italy; and Department of Neurosurgery, Illinois Neurological Institute, University of Illinois College of Medicine at Peoria, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-0050440","series-title":"Surg Radiol Anat","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1007\/BF01653127","article-title":"Anatomic basis of the anterior surgery on the cervical spine: relationships between uncusartery-root complex and vertebral artery injury","volume":"20","year":"1998"},{"key":"b2-0050440","series-title":"Acta Neurochir (Wien)","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1007\/BF01406753","article-title":"Surgical approach to the whole length of the vertebral artery with special reference to the third portion","volume":"51","year":"1980"},{"key":"b3-0050440","series-title":"Minim Invasive Neurosurg","doi-asserted-by":"publisher","first-page":"48","DOI":"10.1055\/s-2008-1053448","article-title":"Oblique transcorporeal drilling to treat anterior compression of the spinal cord at the cervical level","volume":"37","year":"1994"},{"key":"b4-0050440","series-title":"Spine","doi-asserted-by":"publisher","first-page":"2552","DOI":"10.1097\/00007632-199411001-00010","article-title":"Repair of vertebral artery injury during anterior cervical decompression","volume":"19","year":"1994"},{"issue":"2 Suppl","key":"b5-0050440","series-title":"J Neurosurg","first-page":"188","article-title":"The transverse process, intertransverse space, and vertebral artery in anterior approaches to the lower cervical spine","volume":"98","year":"2003"},{"key":"b6-0050440","series-title":"Surgical Neuroangiography","first-page":"73","article-title":"Spinal and spinal cord arteries and veins","volume":"Vol 1","year":"2001"},{"key":"b7-0050440","series-title":"J Spinal Disord","first-page":"233","article-title":"Anatomic considerations of the vertebral artery: implications for anterior decompression of the cervical spine","volume":"11","year":"1998"},{"key":"b8-0050440","series-title":"J Neurosurg Spine","doi-asserted-by":"publisher","first-page":"299","DOI":"10.3171\/spi.2004.1.3.0299","article-title":"The V2 segment of the vertebral artery and its branches","volume":"1","year":"2004"},{"key":"b9-0050440","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"769","DOI":"10.1097\/00006123-199610000-00026","article-title":"Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures","volume":"39","year":"1996"},{"key":"b10-0050440","series-title":"Neurosurgery","first-page":"106","article-title":"Management of the vertebral artery in excision of extradural tumors of the cervical spine","volume":"36","year":"1995"},{"key":"b11-0050440","series-title":"J Bone Joint Surg Br","first-page":"410","article-title":"Vertebral artery injury during anterior decompression of the cervical spine. 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