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The High Cervical Anterolateral Retropharyngeal Approach

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New Trends in Craniovertebral Junction Surgery

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 125))

Abstract

The first high cervical anterolateral retropharyngeal (HCALR) approach was reported by Stevenson et al. for a clivus chordoma in 1966. Anterior approaches to the spine have often been developed in response to problems presented by tuberculous spondylitis. This approach is indicated in anterior high cervical spine cases such as tumour resection, abscess drainage, atlantoaxial subluxation; decompression and stabilization. To our knowledge, only 21 papers in the literature have mentioned this approach. Its main advantage over posterior approaches is easy positioning and minimal need for soft tissue dissection. The HCALR approach provides wide exposure (of the anterior upper cervical spine, lower clivus and brainstem region) and feasibility for instrumentation. The limited space in which important neurovascular and visceral structures course and overlap contributes to the complexity of the anatomy. Navigating this intricate anatomy is essential for the safety of this approach and has been a drawback for utilization of the retropharyngeal corridor. This approach is one of the safest and most effective methods available to access the craniocervical junction. The benefits clearly outweigh the risks and complications.

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References

  1. Song Y, Tharin S, Divi V, Prolo LM, Sirjani DB. Anterolateral approach to the upper cervical spine: case report and operative technique. Head Neck. 2015;37(9):E115–9.

    Article  Google Scholar 

  2. Russo A, Albanese E, Quiroga M, Ulm AJ. Submandibular approach to the C2–3 disc level: microsurgical anatomy with clinical application. J Neurosurg Spine. 2009;10(4):380–9.

    Article  Google Scholar 

  3. Fard SA, Patel AS, Avila MJ, Sattarov KV, Walter CM, Skoch J, Baaj AA. Anatomic considerations of the anterior upper cervical spine during decompression and instrumentation: a cadaveric based study. J Clin Neurosci. 2015;22(11):1810–5.

    Article  Google Scholar 

  4. Haller JM, Iwanik M, Shen FH. Clinically relevant anatomy of high anterior cervical approach. Spine. 2011;36(25):2116–21.

    Article  Google Scholar 

  5. McAfee PC, Bohlman H, Riley LH Jr, Robinson RA, Southwick WO, Nachlas NE. The anterior retropharyngeal approach to the upper part of the cervical spine. J Bone Joint Surg Am. 1987;69(9):1371–83.

    Article  CAS  Google Scholar 

  6. Park S-A, Lee J-H, Nam Y-S, An X, Han S-H, Ha K-Y. Topographical anatomy of the anterior cervical approach for C2–3 level. Eur Spine J. 2013;22(7):1497–503.

    Article  Google Scholar 

  7. Hodgson AR, Stock FE. Anterior spinal fusion: a preliminary communication on the radical treatment of Pott’s disease and Pott’s paraplegia. Br J Surg. 1956;44(185):266–75.

    Article  CAS  Google Scholar 

  8. Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg Spine. 1958;15(6):602–17.

    Article  CAS  Google Scholar 

  9. Robinson RA, Smith GW. Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull John Hopkins Hosp. 1955;96:223–4.

    Google Scholar 

  10. Southwick WO, Robinson RA. Surgical approaches to the vertebral bodies in the cervical and lumbar regions. J Bone Joint Surg. 1957;39-A(3):631–44.

    Article  CAS  Google Scholar 

  11. Stevenson GC, Stoney RJ, Perkins RK. A transcervical transclival approach to the ventral surface of the brain stem for removal of a clivus chordoma. J Neurosurg. 1966;24(2):544–51.

    Article  CAS  Google Scholar 

  12. Russo VM, Graziano F, Russo A. High anterior cervical approach to the clivus and foramen magnum: a microsurgical anatomy study. Oper Neurosurg. 2011;69(1):ONS103–14.

    Article  Google Scholar 

  13. Herkowitz HN. Cervical spine surgery atlas. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.

    Google Scholar 

  14. Kassam AB, Patel A, Welch W, Balzer J, Snyderman C, Hirsch B, Carrau R. The carotid–vertebral space: an ‘extended’ lateral window to the ventromedial cranial base and lower craniocervical junction. Ear Nose Throat J. 2005;84(5):312–5.

    PubMed  Google Scholar 

  15. McDonnell DE, Harrison SJ. Anterolateral cervical approach to the craniovertebral junction. In: Wilkins RH, Rengachary SS, editors. Neurosurgery, vol. 2. 2nd ed. New York: McGraw Hill; 1996. p. 1641–53.

    Google Scholar 

  16. Vender JR, Harrison SJ, McDonnel DE. Fusion and instrumentation at C1–3 via the high anterior cervical approach. J Neurosurg. 2000;92:24–9.

    CAS  PubMed  Google Scholar 

  17. Park SH, Sung JK, Lee SH, et al. High anterior cervical approach to the upper cervical spine. Surg Neurol. 2007;68:519–24.

    Article  Google Scholar 

  18. Laus M, Pignatti G, Malaguti MC, et al. Anterior extraoral surgery to the upper cervical spine. Spine. 1996;21:1687–93.

    Article  CAS  Google Scholar 

  19. Behari S, Banerji D, Trivedi P, et al. Anterior retropharyngeal approach to the cervical spine. Neurol India. 2001;49:324–9.

    Google Scholar 

  20. Finn MA, Macdonald JD. C2–3 anterior cervical fusion: technical report. Clin Spine Surg. 2016;29(10):E536–41.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Alshafai Neurosurgical Academy (ANA), Toronto, ON, Canada

    Nabeel S. Alshafai

  2. Department of Neurosurgery, St Michael’s Hospital, University of Toronto, Toronto, ON, Canada

    V. R. N. Gunness

Authors
  1. Nabeel S. Alshafai
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  2. V. R. N. Gunness
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Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Institute of Neurosurgery, Rome, Italy

    Massimiliano Visocchi

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Alshafai, N.S., Gunness, V.R.N. (2019). The High Cervical Anterolateral Retropharyngeal Approach. In: Visocchi, M. (eds) New Trends in Craniovertebral Junction Surgery. Acta Neurochirurgica Supplement, vol 125. Springer, Cham. https://doi.org/10.1007/978-3-319-62515-7_21

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  • DOI: https://doi.org/10.1007/978-3-319-62515-7_21

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-62514-0

  • Online ISBN: 978-3-319-62515-7

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