OrthoNet

Cervical spine - anterior approach

* position
- supine with sandbag btw shoulder blades
- turn head away from incision
- HOB 30 deg

* landmarks
- hard palate = arch of atlas
- lower border of mandible = C2-3
- hyoid bone = C3
- thyroid cartilage = C4-5
- cricoid cartilage = C6
- carotid tubercle = C6

* incision - transverse incision at level of pathology extending obliquely from midline ot post. border of SCM

* internervous plane
- none superficially
- SCM (spinal accessory n.) & strap muscles (C1-3)
- btw L & R longus colli (segmental branches from C2-7)

* dissection
- incise fascial sheath over platysma in line with skin
- bluntly split platysma long. in line with fibers
- identify ant. border of SCM
- incise fascia ant. to SCM
- retract SCM lat.
- retract sternohyoid & sternothyroid with trachea & esophagus med.
- expose carotid sheath
- develop plane btw med. edge of carotid sheath & midline structures
- cut thru pretracheal fascia on med. side of carotid sheath
- 2 vessels connect carotid sheath with midline structures (sup. & inf. thyroid art.) –> may limit exposure above C3-4
- bluntly dissect heading med. to expose longus colli
- split longus colli long. over midline of vert. bodies
- retract lat.
- place marker & take xray

* dangers
- recurrent laryngeal n. - make be injured with deep dissection
- sympathetic n. & stellate ganglion - lies on longus colli just lat. to vert. bodies
- carotid sheath - protected by ant. border of SCM
- verterbral art. - lies in costotransverse foramen on lat. portion of transverse processes