With the patient in dorsal recumbency, a 30 cm midline ventral skin incision is made centered on the affected vertebra, identified with the help of intra-operative radiographic guidance.
Staples are used to identify the precise localization of the cervical vertebrae of interest during surgery.
The cutaneous, sternohyoid, omohyoid, and sternothyroid muscles are separated longitudinally along the midline to expose the trachea.
Once the trachea is identified, it is retracted to the left and blunt dissection is continued along the right side of the trachea, separating it from the carotid artery and vagosympathetic trunk.
The longus colli muscles are now exposed. The carotid arteries and vagosympathetic trunks are identified, and to some extent protected, with a Penrose drain. Two self-retaining Inge retractors are placed to gain access to the longissimus colli muscles covering the ventral aspect of the spinal column.
A periosteal elevator and Mayo scissors are used to divide the two bellies of the longus colli muscles and to separate the fibers from the ventral process of the vertebra.
The ventral surface of the vertebral column is exposed.