Abstract
Purpose
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.
Methods
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.
Results
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.
Conclusion
Cervical paravertebral anatomy can be depicted with ultrasound imaging techniques. This could be highly clinically significant for the implementation of regional anesthesia techniques.
Similar content being viewed by others
References
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 236–254
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 31:531–535
Choi D, Atchabahian A, Brown A (2005) Cervical plexus block provides postoperative analgesia after clavicle surgery. Anesth Analg 100:1542–1543
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 22:442–446
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 32:116–119
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 91–107
Koscielniak-Nielsen ZJ (2008) Ultrasound-guided peripheral nerve blocks: what are the benefits? Acta Anaesthesiol Scand 52:727–737
Marhofer P, Chan VW (2007) Ultrasound-guided regional anesthesia: current concepts and future trends. Anesth Analg 104:1265–1269
Martinoli C, Bianchi S, Santacrose E et al (2002) Branchial plexus sonography: a technique for assessing the root level. Am J Roentgenol 179:699–702
Roessel T, Wiessner D, Heller A et al (2007) High-resolution ultrasound-guided high interscalene plexus block for carotid endarterectomy. Reg Anesth Pain Med 32:247–253
Sinnatamby CS (2006) Head and neck and spine. In: Sinnatamby CS (ed) Last’s anatomy, 11th edn. Churchill Livingstone, London, pp 341–372
Winnie AP, Ramamurthy S, Durrani Z et al (1975) Interscalene cervical plexus block: a single-injection technique. Anesth Analg 54:370–375
Conflict of interest statement
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Electronic supplementary material
Below is the link to the electronic 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)
Rights and permissions
About this article
Cite this article
Saranteas, T., Paraskeuopoulos, T., Anagnostopoulou, S. et al. Ultrasound anatomy of the cervical paravertebral space: a preliminary study. Surg Radiol Anat 32, 617–622 (2010). https://doi.org/10.1007/s00276-010-0621-9
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00276-010-0621-9