Spine- Anterior approach C spine

Question 1

What are the indications for anterior approach to c spine?

Answer 1

• Cervial Radiculopathy
  
  • anterior cervical discectomy + fusion
• Myelopathy
  
  • anterior corpectomy and fusion
• Tumour
  
  • anterior corpectomy and fusion
• odontoid fracture
  
  • C2 anterior screw osteosynthesis
• Infection/epidural abscess
  
  • anterior cervical discetomy and fusion

Question 2

What does this approach allow level wise?

Answer 2

• Exposure C2 to T1

Question 3

Can you describe the 3 fascia layers in the neck?

Answer 3

• Superifical
  
  • formed from deep cervical fascia
  • Platysma and jugular vein superifical to it
  • surrounds neck ike a collar but breaks at sternocleiodomastoid and trapezius
• Pretracheal
  
  • continuus with carotis sheath lateral
  • superior and inferior vessels go thru the pretracheal fascia to the midline
• Prevertebral
  
  • ​thick and tough fascia that lies infront of prevertebral muscle
  • Cervical sympathetic trunk lies on top

Question 4

What is an important landmark?

Answer 4

• Hyoid bone = C3
• Thyroid cartilage = C4-5
• Circoid cartilage C6

Question 5

Describe the set up and inicision of ant approach to c spine?

Answer 5

• Anaethesia with aiway protection
• Supine
• cross table lateral to enusure correct level

incision

• NO INTERNERVOUS PLANE
• Transverse - location depends on desired levels
• Below C5 only on left = avoid recurrent laryngeal nerve
• Hyoid- C3
• Thyroid cartilage C4-5
• Circoid cartilage C6

Question 6

Describe the dissection of ant approach to c spine?

Answer 6

• Divide fasica over platysma in same horizontal direction as skin
• Retract Platsyma vertically with skin
• Identify anterior border of sternocleiodomastoid
• incise deep cervical fascia overlying ant border SCM
• Retract SCM Laterally and strap muscles ( sternohyoid/sternothryoid) medially
• Cartoid sheath should now be lateral and trachea covered in pretracheal fascia medially
• Incise pretracheal fascia medial
• Retract carotid sheath lateral and trachea medially
• Expose Longus colli muscles and split longitudinally over medial border/ anterior longitudinal ligament- protect recurrent laryngeal nerve
• Dissect subperiosteally to avoid damage to stellate ganglion

Question 7

What is in the cartoid sheath?

Answer 7

• Common carotid artery
• Common carotid vein
• Vagus nerve

Question 8

What are the risks of this ant approach to c spine?

Answer 8

• Damage to the recurrent laryngeal nerve
  
  • Horse, scratchy voice- unilateral cord paralysis
  • esp Right sided incisions
• Thoracic Duct injury- posterior to carotid sheath- injury in left sided incisions
• Upper airway at risk post op
  
  • oedema
  • vocal cord paralysis
  • haematoma- tense ones should be emergency decompressed if causing respiratory compromise
• ​​Sympathetic nerves and Stellate ganglion
  
  • ​damage/ irritation-> Horner’s syndrome
  • = ptosis, anhydrosis, miosis, enopthalmus, and loss of ciliospinal reflex on the affected side of the face
  • Sympathetic chain lies on lateral border of longus colli muscles
  • protect by subperiosteal dissection of longus collis muscles in midline

Question 9

describe the anatomy of the recurrent laryngeal nerve?

Answer 9

Left recurrent laryngeal n

• _Ascends i_n neck between trachea and oesphagus after branching off from vagus nerve at level of arch of aorta

Right recurrent laryngeal n

• Runs alongside the trachea in the neck after hooking around subclavian artery
• crosses lateral to medial to reach midline
• more vunerable than left during exposure