Cervical Spine – Anterior Approach

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