Approaches and procedures

Question 1

what is the anterior approach to the c-spine?

Answer 1

Skin incision:
midline (mid chin-sternal notch) to middle SCM
transverse - better cosmesis - only 1-3 levels
longitudinal for multi-levels

Level:
C3 - hyoid bone
C4-5 - thyroid cartilage
C6 - crycoid cartilage

Superficial dissection:
* skin, fat and platysma - inline with incision
* deep cervical fascia
* Strap medial and SCM lateral
* Pretrachial fascia - danger thyroid arteries
* identify left recurrent laryngeal nerve
* carotid sheath lateral (feel pulse) and oesophagus/ trachea medially

Deep dissection:
* elevate longus coli off vertebrae and split ALL
* DANGER - sympathetic chain in lateral longus coli C6

Question 2

why is the anterior approach to the C-spine commonly performed on the left?

Answer 2

left recurrent laryngeal nerve has the more consistent course

Question 3

how do you perform an anterior c-spine discektomy?

Answer 3

• anterior approach to c-spine
• hinterman retractors to distract joint space
• annulus fibrosis incised - disc material removed to the PLL using rongeurs
• burr to remove anterior osteophytes