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

– 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

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