Surgical and Radiologic Anatomy

, Volume 32, Issue 6, pp 617–622 | Cite as

Ultrasound anatomy of the cervical paravertebral space: a preliminary study

  • Theodosios SaranteasEmail author
  • Tilemachos Paraskeuopoulos
  • Sofia Anagnostopoulou
  • Ilias Kanellopoulos
  • Michael Mastoris
  • Georgia Kostopanagiotou
Medical Imaging



The aim of the study was to examine the ultrasound anatomy of the cervical paravertebral space in order to facilitate the implementation of sonographically guided regional anesthesia techniques for this region.


Twenty volunteers were recruited, and the anatomic components of the cervical paravertebral space were sonographically examined. The transducer was positioned in the axial and coronal plane at the posterior cervical triangle. The cervical transverse processes with their respective nerve roots, the deep cervical fascia and the paravertebral muscles were identified.


There was excellent visualization of the C-3, C-4, C-5, C-6 and C-7 transverse processes in all cases. Excellent visualization of the scalene muscles, vertebral artery and deep cervical fascia was also achieved in all cases. Visualization of the levator of scapula muscle was difficult in 9 and excellent in 11 out of the 20 cases. In all cases, visualization of the C-1, C-2 and C-3 nerve roots was unfeasible. The identification of the C-4 nerve root was excellent in 3, difficult in 6 and unfeasible in 11 out of the 20 cases. The C-5, C-6 and C-7 nerve roots were excellently identified in all cases. The C-8 nerve root was identified only in 8 of the 20 cases. The cervical nerve roots also showed high variation, dividing into more than one branch as they exited the cervical transverse processes.


Cervical paravertebral anatomy can be depicted with ultrasound imaging techniques. This could be highly clinically significant for the implementation of regional anesthesia techniques.


Ultrasound Cervical paravertebral anatomy Cervical nerve roots 


Conflict of interest statement

The authors declare that they have no conflict of interest.

Supplementary material

Initially, the vertebra artery was clearly depicted in the coronary plane. The transducer was then tilted towards posterior cervical triangle of the neck. At this point, the vertebra artery disappeared and the nerve roots (hypoechoic round structures) were seen as they exited between the cervical transverse processes and entered the cervical region (MPEG 1744 kb)


  1. 1.
    Adriani J (1985) Blocking of spinal nerves. In: Adriani J (ed) Labat’s regional anesthesia: techniques and clinical applications, 4th edn. Warring H Green, St Louis, pp 236–254Google Scholar
  2. 2.
    Benkhadra M, Faust A, Ladoire S et al (2009) Comparison of fresh and Thiel’s embalmed cadavers according to the suitability for ultrasound-guided regional anesthesia of the cervical region. Surg Radiol Anat 31:531–535CrossRefPubMedGoogle Scholar
  3. 3.
    Choi D, Atchabahian A, Brown A (2005) Cervical plexus block provides postoperative analgesia after clavicle surgery. Anesth Analg 100:1542–1543CrossRefPubMedGoogle Scholar
  4. 4.
    Davies MJ, Silbert BS, Scott DA et al (1997) Superficial and deep cervical plexus block for carotid artery surgery: a prospective clinical study of 1000 blocks. Reg Anesth Pain Med 22:442–446CrossRefGoogle Scholar
  5. 5.
    Dhonneur G, Saidi NE, Merle JC et al (2007) Demonstration of the spread of injection with deep cervical plexus block: a case series. Reg Anesth Pain Med 32:116–119PubMedGoogle Scholar
  6. 6.
    Hadzic A, Vloka J (2004) Cervical plexus block. In: Hadzic A, Vloka J (eds) Peripheral nerve blocks. Principles and practice, 1st edn. McGraw-Hill, New York, pp 91–107Google Scholar
  7. 7.
    Koscielniak-Nielsen ZJ (2008) Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand 52:727–737PubMedCrossRefGoogle Scholar
  8. 8.
    Marhofer P, Chan VW (2007) Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg 104:1265–1269CrossRefPubMedGoogle Scholar
  9. 9.
    Martinoli C, Bianchi S, Santacrose E et al (2002) Branchial plexus sonography: a technique for assessing the root level. Am J Roentgenol 179:699–702Google Scholar
  10. 10.
    Roessel T, Wiessner D, Heller A et al (2007) High-resolution ultrasound-guided high interscalene plexus block for carotid endarterectomy. Reg Anesth Pain Med 32:247–253PubMedGoogle Scholar
  11. 11.
    Sinnatamby CS (2006) Head and neck and spine. In: Sinnatamby CS (ed) Last’s anatomy, 11th edn. Churchill Livingstone, London, pp 341–372Google Scholar
  12. 12.
    Winnie AP, Ramamurthy S, Durrani Z et al (1975) Interscalene cervical plexus block: a single-injection technique. Anesth Analg 54:370–375PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2010

Authors and Affiliations

  • Theodosios Saranteas
    • 1
    • 5
    Email author
  • Tilemachos Paraskeuopoulos
    • 2
  • Sofia Anagnostopoulou
    • 3
  • Ilias Kanellopoulos
    • 1
  • Michael Mastoris
    • 4
  • Georgia Kostopanagiotou
    • 1
  1. 1.2nd Department of Anesthesiology, Attikon Hospital, School of MedicineUniversity of AthensAthensGreece
  2. 2.Department of AnesthesiologyGeneral Hospital of Athens “G.Gennimatas”AthensGreece
  3. 3.Department of Anatomy, School of MedicineUniversity of AthensAthensGreece
  4. 4.Department of Dento-maxillofacial Radiology, Dental SchoolUniversity of AthensAthensGreece
  5. 5.AthensGreece

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