Anatomical substantiation of direct anastomoses during contralateral transfer of the perineural complex of the spinal nerve C7, the middle trunk and its anterior division

Relevance. To establish the shortest, safest and most effective route Contra-lateral transfer of spinal nerve C7 is an urgent issue in repairing damage to the nervous system. Objective. The goal is to identify the anatomical conditions indicated for direct anastomosis during contralateral transfer of the roots, the perineural complex of the spinal nerve C7, the middle trunk and its anterior division. Material and methods. On 105 cadavers of men and women aged 40—97 years, the dimensions of the neck (n=105), C7 cervical vertebra (n=36), C7 cervical segment of the spinal cord, radicular filaments and roots (n=24), C7 spinal nerve, the middle trunk, its anterior division at the epineural and perineural levels (n=121). Based on the data obtained, life-size geometric models of 10 surgical paths were built and the following indicators were determined: donor length and path length, frequency of direct anastomoses and, if necessary, the size of the nerve insertion. The minimum and maximum values, median (Me), quartile intervals [Q1; Q3], the significance of intergroup differences were determined using the Mann—Whitney U-test, and pairwise contingency was determined by Spearman (rs). Results. The total length of the anterior radicular threads and root (25 [23.5; 26.5] mm), posterior radicular threads and root (28 [25; 30] mm) in 83.3—95.8% of cases is sufficient for direct anastomosis with contralateral transfer by intravertebral tracts. The total length of the perineural complex of the spinal nerve C7, the middle trunk and its anterior division (75 [66; 85] mm) is sufficient in 100% of cases for direct anastomosis with contralateral transfers through and prevertebral tracts, in 83.3% with retrotracheal premuscular, in 81% — pretracheal periosomnia, in 8.3% — retrosternal-cleidomastoid, in 2.5% — subcutaneous. Conclusion. The frequency of direct anastomoses can be increased by 2—2.7 times by using the middle trunk, anterior division and perineural complex of spinal nerve C7. Every 10 mm the surgical path is removed from the middle of the neck, the length of the path increases by 20 mm, the length of the nerve insertion increases by 10 mm and the frequency of direct anastomosis decreases by 10%.