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Anterior Approach to the Cervical Spine

PreOp Planning

  • consider NG tube and foley catheter;
  • have proper sized C-collar available for post operative care;
  • position: supine w/ halter cervical traction (3-5 lbs) w/ head turned slightly to the right;
    • consider placing a rolled towel between the shoulder blades;
  • prep for iliac crest bone graft;
  • hall burr is helpful for shaping bone graft;

Anatomy

hyoid cartilage lies at the level of C3;

carotid tubercle

cricoid cartilage lies at the level of C6;

vascular structures

  • inferior thyroid artery course horizontally toward midline as branch as branch of thyrocervical trunk at the level of C7;
  • carotid sheath (containing carotid artery, internal jugular vein, and the vagus nerve) lie lateral to the dissection;
  • vertebral arteries lie posteriorly, and can be injured w/ anterior approach;

nerves

  • right sided surgical approaches to the cervical spine are generally avoided in order to avoid the aberrant course of the recurrent laryngeal nerve;
  • left recurrent laryngeal nerve, is protected during the dissection as it runs between the trachea and the esophagus;
  • cerival sympathetic chain:

thoracic duct

  • lies on the left side, lateral to the esophagus;
  • at the level of T1, it passes anterior to the anterior scalene muscle, loops around the subclavian artery, and enters the subclavian vein;
  • when exposure at this level is required, consider a right sided approach;

Positioning

  • supine, posterior interscapular role, and Halter traction (5 lbs);

Surgical Approach

  • transverse incision from the anterior edge of the sternocliedomastoid muscle to a point just shy of the midline;
  • incision is carried down to the platysma muscle and fasci;
    • metzenbaum scissors are used to bluntly dissect beneath the platysma muscle and are used to elevate the platysma;
    • platysma muscle is incised in line with the incision;
  • carotid artery is palpated and protected;
  • blunt dissection then procedes posteriorly and medially to the midline of the vertebral body;
  • the disc space is identified;
  • the anterior edge longus coli muscle is gently mobilized laterally along both sides of the disc space;
    • bleeding may be encountered if the dissection proceeds towards the center of the vertebral body;

Anterior Arthrodesis of Cervical Spine »