OrthoNet

Anterior Approach to Midcervical Spine

- Gardner-Wells tongs for traction & to keep neck slightly extended or Mayfield head rest
- landmarks
hard palate- arch of atlas
lower border of mandible- C2-3
hyoid bone- C3
thyroid cartilage- C4-5
cricoid cartilage/carotid tubercle-C6
- transverse incision from midline à posterior border of SCM on left side
- split platysma transversely
- incise deep cervical fascia anterior to SCM & bluntly dissect between SCM & strap muscles
- retract carotid sheath laterally & trachea/esophagus medially
- divide prevertebral fascia in midline
- retract longus colli laterally to expose ALL
- divide ALL in midline to expose vertebral body & disk

Dangers:
- recurrent laryngeal nerve - usu safe with L-sided approach as nerve runs from arch of aorta between trachea & esophagus
- superior thyroid art. may limit dissection above C3-4 & inferior thyroid art. below C6
- sympathetic nerves & stellate ganglion safe if avoid dissection onto transverse processes
- carotid sheath - carotid artery, IJV & vagus nerve
- esophagus - protect on medial deep retraction with longus colli