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Anterior Approaches to the Cervical Spine

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Lumbar Spine Access Surgery

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Abstract

Anterior cervical spine surgery is widely accepted for treating spondylosis, disc herniation, spinal cord tumors, and vascular diseases. Since many of these pathologies appear anterior to the spinal cord, the anterior approach gives the surgeon the ability to visualize the lesion. Damage to muscles surrounding the cervical spine is also minimized by utilizing an anterior approach. This chapter will review the main methods of anterior access to the upper cervical spine/craniovertebral junction and to the subaxial cervical spine as well as the preparation, positioning, and incision choices associated with each.

Anterior cervical spine surgery does not come without risks. Utilizing an anterior cervical spine approach can expose vulnerable structures such as the esophagus, trachea, recurrent laryngeal nerve, and vasculature. This can result in complications including dural tear and cerebrospinal fluid leak, esophageal injury, vascular injury and stroke, airway obstruction, and adjacent segment disease. Recognition and treatment will be covered in this chapter as they relate to spinal and vascular surgeons.

Although anterior cervical spine surgery can be utilized for many pathologies, there are still some pathologies which may be better suited to be treated by posterior cervical spine surgery. This chapter will review the guidelines for deciding to use an anterior approach in cervical spine surgery.

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References

  1. Arumalla K, Bansal H, Jadeja J, et al. Anterior approach to the cervical spine: elegance lies in its simplicity. Asian. J Neurosurg. 2021;16(4):669–84. Published 2021 Dec 18. https://doi.org/10.4103/ajns.AJNS_313_20.

    Article  Google Scholar 

  2. Tandon M, Saigal D. Essentials of neuroanethesia: spinal surgery. Cambridge, MA: Academic; 2017. p. 399–439. https://doi.org/10.1016/B978-0-12-805299-0.00024-5.

    Book  Google Scholar 

  3. Vigo V, Pastor-Escartín F, Doniz-Gonzalez A, et al. The smith-Robinson approach to the subaxial cervical spine: a stepwise microsurgical technique using volumetric models from anatomic dissections. Oper Neurosurg (Hagerstown). 2020;20(1):83–90. https://doi.org/10.1093/ons/opaa265.

    Article  PubMed  Google Scholar 

  4. Cheung KM, Mak KC, Luk KD. Anterior approach to cervical spine. Spine (Phila Pa 1976). 2012;37(5):E297–302. https://doi.org/10.1097/BRS.0b013e318239ccd8.

    Article  PubMed  Google Scholar 

  5. Siribumrungwong K, Sinchai C, Tangtrakulwanich B, Chaiyamongkol W. Reliability and accuracy of palpable anterior neck landmarks for the identification of cervical spinal levels. Asian Spine J. 2018;12(1):80–4. https://doi.org/10.4184/asj.2018.12.1.80.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Razi A, Saleh H, DeLacure MD, Kim Y. Anterior approach to the subaxial cervical spine: pearls and pitfalls. J Am Acad Orthop Surg. 2021;29(5):189–95. https://doi.org/10.5435/JAAOS-D-17-00891.

    Article  PubMed  Google Scholar 

  7. Hsu W, Wolinsky JP, Gokaslan ZL, Sciubba DM. Transoral approaches to the cervical spine. Neurosurgery. 2010;66(3 Suppl):119–25. https://doi.org/10.1227/01.NEU.0000365748.00721.0B.

    Article  PubMed  Google Scholar 

  8. Watkins RG. Transoral approach to C1–C2. In: Watkins III R, Watkins IV R, editors. Surgical approaches to the spine. New York, NY: Springer; 2015. https://doi.org/10.1007/978-1-4939-2465-3_2.

    Chapter  Google Scholar 

  9. Li W, Wang B, Feng X, Hua W, Yang C. Preoperative management and postoperative complications associated with transoral decompression for the upper cervical spine. BMC Musculoskelet Disord. 2022;23(1):128. https://doi.org/10.1186/s12891-022-05081-7.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Crockard HA. Transoral surgery: some lessons learned. Br J Neurosurg. 1995;9(3):283–93. https://doi.org/10.1080/02688699550041304.

    Article  CAS  PubMed  Google Scholar 

  11. Apostolides P, Vishteh A, Galler R, Sonntag V. Technique of transoral odontoidectomy. In: Mayer HM, editor. Minimally invasive spine surgery. Berlin: Springer; 2006. https://doi.org/10.1007/3-540-29490-2_7.

    Chapter  Google Scholar 

  12. Yee TJ, Swong K, Park P. Complications of anterior cervical spine surgery: a systematic review of the literature. J Spine Surg. 2020;6(1):302–22. https://doi.org/10.21037/jss.2020.01.14.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Schaberg MR, Altman JI, Shapshay SM, Woo P. Cerebrospinal fluid leak after anterior cervical disc fusion: an unusual cause of dysphagia and neck mass. Laryngoscope. 2007;117(11):1899–901. https://doi.org/10.1097/mlg.0b013e31812eee01.

    Article  PubMed  Google Scholar 

  14. Fountas KN, Kapsalaki EZ, Johnston KW. Cerebrospinal fluid fistula secondary to dural tear in anterior cervical discectomy and fusion. Spine. 2005;30(10):E277–80. https://doi.org/10.1097/01.brs.0000162399.93992.5c.

    Article  PubMed  Google Scholar 

  15. Sugawara T, Itoh Y, Hirano Y, Higashiyama N, Shimada Y, Kinouchi H, et al. Novel dural closure technique using polyglactin acid sheet prevents cerebrospinal fluid leakage after spinal surgery. Neurosurgery. 2005;57(suppl_4):ONS-290-ONS-294. https://doi.org/10.1227/01.neu.0000176410.65750.c0.

    Article  Google Scholar 

  16. Fang Z, Tian R, Jia Y-T, Xu T-T, Liu Y. Treatment of cerebrospinal fluid leak after spine surgery. Chin J Traumatol. 2017;20(2):81–3. https://doi.org/10.1016/j.cjtee.2016.12.002.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Lee TS, Appelbaum EN, Sheen D, Han R, Wie B. Esophageal perforation due to anterior cervical spine hardware placement: case series. Int J Otolaryngol. 2019;2019:1–9. https://doi.org/10.1155/2019/7682654.

    Article  CAS  Google Scholar 

  18. Dakwar E, Uribe JS, Padhya TA, Vale FL. Management of delayed esophageal perforations after anterior cervical spinal surgery. SPI. 2009;11(3):320–5. https://doi.org/10.3171/2009.3.spine08522.

    Article  Google Scholar 

  19. Dantas FLR, Dantas F, Mendes PD, Sandes BL, Fonseca FG. Primary repair of esophageal perforation following anterior cervical fusion. Cureus. 2020;12(11):e11590. https://doi.org/10.7759/cureus.11590.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Kang MS, Kim KH, Park JY, Kuh SU, Chin DK, Jin BH, et al. Management of Esophageal and Pharyngeal Perforation as complications of anterior cervical spine surgery. World Neurosurg. 2017;102:275–83. https://doi.org/10.1016/j.wneu.2017.02.130.

    Article  PubMed  Google Scholar 

  21. Burke JP, Gerszten PC, Welch WC. Iatrogenic vertebral artery injury during anterior cervical spine surgery. Spine J. 2005;5(5):508–14. https://doi.org/10.1016/j.spinee.2004.11.015.

    Article  PubMed  Google Scholar 

  22. Hershman SH, Kunkle WA, Kelly MP, Buchowski JM, Ray WZ, Bumpass DB, et al. Esophageal perforation following anterior cervical spine surgery: case report and review of the literature. Glob Spine J. 2017;7(1_suppl):28S–36S. https://doi.org/10.1177/2192568216687535.

    Article  Google Scholar 

  23. Inamasu J, Guiot BH. Iatrogenic carotid artery injury in neurosurgery. Neurosurg Rev. 2005;28(4):239–47. https://doi.org/10.1007/s10143-005-0412-7.

    Article  PubMed  Google Scholar 

  24. Pollard ME, Little PW. Changes in carotid artery blood flow during anterior cervical spine surgery. Spine. 2002;27(2):152–5. https://doi.org/10.1097/00007632-200201150-00006.

    Article  PubMed  Google Scholar 

  25. Yeh Y-C, Sun W-Z, Lin C-P, Hui C-K, Huang I-R, Lee T-S. Prolonged retraction on the Normal common carotid artery induced lethal stroke after cervical spine surgery. Spine. 2004;29(19):E431–4. https://doi.org/10.1097/01.brs.0000141177.95850.b1.

    Article  PubMed  Google Scholar 

  26. Sagi HC, Beutler W, Carroll E, Connolly PJ. Airway complications associated with surgery on the anterior cervical spine. Spine. 2002;27(9):949–53. https://doi.org/10.1097/00007632-200205010-00013.

    Article  PubMed  Google Scholar 

  27. Shintani A, Zervas NT. Consequence of ligation of the vertebral artery. J Neurosurg. 1972;36(4):447–50. https://doi.org/10.3171/jns.1972.36.4.0447.

    Article  CAS  PubMed  Google Scholar 

  28. Lee S-H, Kim K-T, Suk K-S, Park K-J, Oh K-I. Effect of retropharyngeal steroid on prevertebral soft tissue swelling following anterior cervical discectomy and fusion. Spine. 2011;36(26):2286–92. https://doi.org/10.1097/brs.0b013e318237e5d0.

    Article  PubMed  Google Scholar 

  29. Suk K-S, Kim K-T, Lee S-H, Park S-W. Prevertebral soft tissue swelling after anterior cervical discectomy and fusion with plate fixation. Int Orthop. 2006;30:290. https://doi.org/10.1007/s00264-005-0072-9.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Kwon B, Yoo JU, Furey CG, Rowbottom J, Emery SE. Risk factors for delayed Extubation after single-stage, multi-level anterior cervical decompression and posterior fusion. J Spinal Disord Techn. 2006;19(6):389–93. https://doi.org/10.1097/00024720-200608000-00002.

    Article  Google Scholar 

  31. Bazaz R, Lee MJ, Yoo JU. Incidence of dysphagia after anterior cervical spine surgery. Spine. 2002;27(22):2453–8. https://doi.org/10.1097/00007632-200211150-00007.

    Article  PubMed  Google Scholar 

  32. Lee MJ, Bazaz R, Furey CG, Yoo J. Risk factors for dysphagia after anterior cervical spine surgery: a two-year prospective cohort study. Spine J. 2007;7(2):141–7. https://doi.org/10.1016/j.spinee.2006.02.024.

    Article  PubMed  Google Scholar 

  33. Joaquim AF, Murar J, Savage JW, Patel AA. Dysphagia after anterior cervical spine surgery: a systematic review of potential preventative measures. Spine J. 2014;14(9):2246–60. https://doi.org/10.1016/j.spinee.2014.03.030.

    Article  PubMed  Google Scholar 

  34. Cho SK, Lu Y, Lee D-H. Dysphagia following anterior cervical spinal surgery. Bone Joint J. 2013;95-B(7):868–73. https://doi.org/10.1302/0301-620X.95B7.31029.

    Article  CAS  PubMed  Google Scholar 

  35. Fogel GR, McDonnell MF. Surgical treatment of dysphagia after anterior cervical interbody fusion. Spine J. 2005;5(2):140–4. https://doi.org/10.1016/j.spinee.2004.06.022.

    Article  PubMed  Google Scholar 

  36. Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH. Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. JBJS. 1999;81(4):519–28.

    Article  CAS  Google Scholar 

  37. Carrier CS, Bono CM, Lebl DR. Evidence-based analysis of adjacent segment degeneration and disease after ACDF: a systematic review. Spine J. 2013;13(10):1370–8.

    Article  PubMed  Google Scholar 

  38. Verma K, Gandhi SD, Maltenfort M, Albert TJ, Hilibrand AS, Vaccaro AR, Radcliff KE. Rate of adjacent segment disease in cervical disc arthroplasty versus single-level fusion: meta-analysis of prospective studies. Spine. 2013;38(26):2253–7.

    Article  PubMed  Google Scholar 

  39. Mummaneni PV, Kaiser MG, Matz PG, Anderson PA, Groff MW, Heary RF, et al. Cervical surgical techniques for the treatment of cervical spondylotic myelopathy. SPI. 2009;11(2):130–41. https://doi.org/10.3171/2009.3.SPINE08728.

    Article  Google Scholar 

  40. Bono CM, Ghiselli G, Gilbert TJ, Kreiner DS, Reitman C, Summers JT, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. Spine J. 2011;11(1):64–72. https://doi.org/10.1016/j.spinee.2010.10.023.

    Article  PubMed  Google Scholar 

  41. Anderberg L, Annertz M, Rydholm U, Brandt L, Säveland H. Selective diagnostic nerve root block for the evaluation of radicular pain in the multilevel degenerated cervical spine. Eur Spine J. 2006;15(6):794–801. https://doi.org/10.1007/s00586-005-0931-5.

    Article  PubMed  Google Scholar 

  42. Childress MA, Becker BA. Nonoperative management of cervical radiculopathy. Am Fam Physician. 2016;93(9):746–54.

    PubMed  Google Scholar 

  43. Matz PG, Holly LT, Groff MW, Vresilovic EJ, Anderson PA, Heary RF, et al. Indications for anterior cervical decompression for the treatment of cervical degenerative radiculopathy. SPI. 2009;11(2):174–82. https://doi.org/10.3171/2009.3.SPINE08720.

    Article  Google Scholar 

  44. Matz PG, Ryken TC, Groff MW, Vresilovic EJ, Anderson PA, Heary RF, et al. Techniques for anterior cervical decompression for radiculopathy. SPI. 2009;11(2):183–97. https://doi.org/10.3171/2009.2.SPINE08721.

    Article  Google Scholar 

  45. Jacobs W, Willems PC, van Limbeek J, Bartels R, Pavlov P, Anderson PG, et al. Single or double-level anterior interbody fusion techniques for cervical degenerative disc disease. Cochrane Database Syst Rev. 2011;1:CD004958. https://doi.org/10.1002/14651858.CD004958.pub2.

    Article  Google Scholar 

  46. Boselie TF, Willems PC, van Mameren H, de Bie R, Benzel EC, van Santbrink H. Arthroplasty versus fusion in single-level cervical degenerative disc disease. Cochrane Database Syst Rev. 2012;9:CD009173. https://doi.org/10.1002/14651858.CD009173.pub2.

    Article  Google Scholar 

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Author information

Authors and Affiliations

  1. Georgetown University School-Medicine, Washington, DC, USA

    Michael Hammer

  2. Ortho Bethesda, Bethesda, MD, USA

    Claire van Ekdom & Eric Feuchtbaum

  3. Harbor-UCLA Medical Center, Torrance, CA, USA

    Brian Panish

Authors
  1. Michael Hammer
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  2. Claire van Ekdom
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  3. Brian Panish
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  4. Eric Feuchtbaum
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Corresponding author

Correspondence to Eric Feuchtbaum .

Editor information

Editors and Affiliations

  1. Aligned Orthopaedics, Bethesda, MD, USA

    Joseph R. O'Brien

  2. Department of Orthopedic Surgery, The George Washington University, Washington, DC, USA

    Jeffrey B. Weinreb

  3. Vascular Surgery, Inova Health System, Falls Church, VA, USA

    Joseph C. Babrowicz

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Hammer, M., van Ekdom, C., Panish, B., Feuchtbaum, E. (2023). Anterior Approaches to the Cervical Spine. In: O'Brien, J.R., Weinreb, J.B., Babrowicz, J.C. (eds) Lumbar Spine Access Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-48034-8_34

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  • DOI: https://doi.org/10.1007/978-3-031-48034-8_34

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  • Online ISBN: 978-3-031-48034-8

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