Ultrasound anatomy of the cervical paravertebral space: a preliminary study
- 356 Downloads
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.
KeywordsUltrasound Cervical paravertebral anatomy Cervical nerve roots
Conflict of interest statement
The authors declare that they have no conflict of interest.
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.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
- 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
- 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
- 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