Authors of section

Authors

Carlo Bellabarba, Marcelo Gruenberg, Cumhur Oner

Executive Editor

Luiz Vialle

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Anterior approach to the cervical spine

1. Incision

The side of the incision, left or right mainly depends on the surgeons' preference.

By using a left sided approach the recurrent laryngeal nerve can be avoided.

Be using a right sided approach the same nerve can be visualized and protected.

anterior approach to the cervical spine

The transverse incision is made at the level required. A transverse incision will give a better cosmetic outcome, however, only limited exposure.

anterior approach to the cervical spine

If a multilevel fixation is considered, a more longitudinal incision is required.

anterior approach to the cervical spine

Injuries of the esophagus can be associated with fractures or occur as a complication of the approach.

In addition to the tracheotube a nasogastric tube should be inserted to better identify and thus help prevent accidental injury to the esophagus.

These are serious and potentially lethal complications. Consultation with thoracic or ENT surgeons should be obtained.

anterior approach to the cervical spine

2. Dissection

Platysma muscle is transected in line with the skin incision.

anterior approach to the cervical spine

The deep cervical fascia is identified and divided along the anteromedial border of the sternocleidomastoid muscle.

anterior approach to the cervical spine

The carotid pulse is palpated and the dissection is directed medial to the carotid sheath.

anterior approach to the cervical spine

A finger is then used for blunt dissection between the carotid sheath laterally and trachea and esophagus medially down to the prevertebral fascia.

Note: In case of carotid artery injury direct pressure should be applied and vascular surgery consultation requested urgently.

anterior approach to the cervical spine

The recurrent laryngeal nerve is identified and protected.

anterior approach to the cervical spine

The prevertebral fascia is cut longitudinally allowing direct visualization of the vertebra and the longus colli muscle.

The level is verified with fluoroscopy. The longus coli muscle is mobilized and distractors are placed.

anterior approach to the cervical spine

3. Closure

The platysma muscle is sutured followed by a subcutaneous and skin closure.

anterior approach to the cervical spine

A wound drain is inserted through a separate stab incision.

anterior approach to the cervical spine