Cervical spine – posterior approach

* position – prone

* incision – midline of neck

* internervous plane – midline btw L & R paracervical muscles (post. rami of cervical n.)

* dissection
– continue incision down to spinous processes
– expose post. aspect of vert. subperiosteally
– identify lig. flavum running btw adj. lamina
– remove from leading edge of lamina of inf. vert.
– remove remaining lig. flavum & lamina
– retract SC med.
– identify post. portionof vert. body

* dangers
– SC & nerve roots – don’t retract too vigorously
– venous plexus in canal – use gelfoam or bipolar cautery
– segmental blood supply
> may be cut or stretched as muscles stripped past facet joints
> usu causes no problems
– vert. art. – protected by bone b/c within transverse foramen

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