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To determine local variations of cervical sympathetic ganglia (CSG) according to vertebral levels on preoperative neck magnetic resonance imaging (MRI) by designating carotid artery (CA) as the standard landmark at the center, in attempts to prevent injury to CSG in the anterior-anterolateral approaches performed in the cervical spinal region. The retrospective study reviewed neck MRI images of 281 patients, of which the images of 231 patients were excluded from the study based on the exclusion criteria. As a result, the MRI images of