Anterior Cervical Approaches to the Spine
The significant anatomical landmarks for differentiating the approaches to the cervical spine presented in Table 1.1 are the stemocleidomastoid muscle, the carotid sheath, and the longus coli muscle (Fig. 1A).I-8 Categorization is based on the direction of approach relative to these specific structures, as demonstrated in the table. For example, approach no. 1 is medial to the stemocleidomastoid muscle (therefore, retracting it laterally) and medial to the carotid sheath (therefore, retracting it laterally as well). Approach no. 7 is directed lateral to the stemocleidomastoid muscle and lateral to the carotid sheath. A significant aspect of these approaches is whether to approach the carotid sheath medially or laterally. Approaching the carotid sheath medially and retracting laterally often requires sacrifice of vessels coursing from the carotid sheath to the medial musculovisceral column. Nerves running from lateral to medial also must be retracted. Approaching the carotid sheath laterally and retracting it medially, as in the anterolateral approaches,l-5 produces a more avascular plane but may also result in a more limited exposure. Both the anteromedial and the anterolateral approaches have common points of dissection and anatomy.
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- 2.Verbest H: Anterolateral operations for fractures and dislocations in the middle and lower parts of the cervical spine. J Bone Joint Surg 51A (8):1489–1530, 1969.Google Scholar
- 4.Nanson EM: The anterior approach to upper dorsal sympathectomy. Surg Gynecol Ohstet 104:118–120, 1957.Google Scholar
- 5.Whitesides T Jr, McDonald AP: Lateral retropharyngeal approach to the upper cervical spine. Orthop Clin N Am 9 (4):1115–1127,1978.Google Scholar
- 6.Riley LH: Surgical approaches to the anterior structures of the cervical spine. Clin Orthop 91 (16):10–20, 1973.Google Scholar
- Robinson RA, Southwick WO: Surgical approaches to the cervical spine. In: American Academy of Orthopaedic Surgery: Instructional Course Lectures, Vol. XVII. St. Louis, Mosby, 1960, 299–330.Google Scholar
- 8.Robinson RA: Approaches to the cervical spine CI-Tl. Chapter 22 in Schmidek HH, Sweet WH (eds): Current Techniques in Operative Neurosurgery. New York, Grune & Stratton, 1978, pp 205–302.Google Scholar
- 9.Cloward R: Ruptured Cenical Intervertebral Discs. Codman Signature Series 4. Codman and Shurtleff, 1974.Google Scholar
- 10.Henry AK: Extensive Exposure. Baltimore, Williams & Wilkins, 1959, pp 53–72.Google Scholar