Approaches to the cervical spine

Anterior approach to cervical spine

01. Skin incision and Platysma m.
The first step of the anterior cervical approach is a linear skin incision (in this case on the left side). The platysma muscle is then cut and elevated. The sternocleidomastoid m. is presented. The interfascial dissection along the antero-medial border of the sternocleidomastoid m. is followed.
02. Interfascial dissection and exposure of the great cervical vessels
The internal carotid artery and the jugular vein are exposed.
03. Lateral continuation of the dissection
If the dissection is continued laterally to the great cervical vessels, the exposure reaches the longus coli m. and the sympathetic chain. This is a surgical approach for cervical foraminotomy and the vertebral artery. This 3D model also exemplifies the importance of the accurate placement of the retractor below the longus colli m. in standard anterior cervical discectomy and fusion procedures. If the retractor is above the longus colli m., the sympathetic chain can be damaged resulting in Horner's syndrome.
04. Medial continuation of the dissection
If the dissection is continued medially to the great vessels and the latter are retracted laterally, the prevertebral fascia is reached. After incision of the prevertebral fascia is performed, the trachea and esophagus are retracted medially and the great vessels laterally. It is important to elevate the longus colli m. and the retractor must be placed below the latter in order to avoid sympathetic chain injury.