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The High Cervical Anterolateral Retropharyngeal Approach

  • Nabeel S. Alshafai
  • V. R. N. Gunness
Chapter
Part of the Acta Neurochirurgica Supplement book series (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.

Keywords

Craniocervical junction Anterior approach Anatomical corridors Minimally invasive 

References

  1. 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.CrossRefGoogle Scholar
  2. 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.CrossRefGoogle Scholar
  3. 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.CrossRefGoogle Scholar
  4. 4.
    Haller JM, Iwanik M, Shen FH. Clinically relevant anatomy of high anterior cervical approach. Spine. 2011;36(25):2116–21.CrossRefGoogle Scholar
  5. 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.CrossRefGoogle Scholar
  6. 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.CrossRefGoogle Scholar
  7. 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.CrossRefGoogle Scholar
  8. 8.
    Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg Spine. 1958;15(6):602–17.CrossRefGoogle Scholar
  9. 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. 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.CrossRefGoogle Scholar
  11. 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.CrossRefGoogle Scholar
  12. 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.CrossRefGoogle Scholar
  13. 13.
    Herkowitz HN. Cervical spine surgery atlas. 2nd ed. Philadelphia: Lippincott Williams & Wilkins; 2004.Google Scholar
  14. 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.PubMedGoogle Scholar
  15. 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. 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.PubMedGoogle Scholar
  17. 17.
    Park SH, Sung JK, Lee SH, et al. High anterior cervical approach to the upper cervical spine. Surg Neurol. 2007;68:519–24.CrossRefGoogle Scholar
  18. 18.
    Laus M, Pignatti G, Malaguti MC, et al. Anterior extraoral surgery to the upper cervical spine. Spine. 1996;21:1687–93.CrossRefGoogle Scholar
  19. 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. 20.
    Finn MA, Macdonald JD. C2–3 anterior cervical fusion: technical report. Clin Spine Surg. 2016;29(10):E536–41.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  • Nabeel S. Alshafai
    • 1
  • V. R. N. Gunness
    • 2
  1. 1.Alshafai Neurosurgical Academy (ANA)TorontoCanada
  2. 2.Department of Neurosurgery, St Michael’s HospitalUniversity of TorontoTorontoCanada

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