Alterations in axial curvature of the cervical spine with a combination of rotation and extension in the conventional anterior cervical approach

Abstract COMPRESSION OF THE spinal cord by the degenerating cervical spine tends to lead to progressive clinical symptoms over a variable period of time. Surgical decompression can stop this process and lead to recovery of function. The choice of surgical technique depends on what is causing the compression of the spinal cord. This article reviews the symptoms and assessment for cervical spondylotic myelopathy (clinically evident compression of the spinal cord) and discusses the indications for decompression of the spinal cord anteriorly.

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The Application of Endoscopic Technique in High Cervical Anterior Approach to the Craniovertebral Junction

10.21203/rs.3.rs-133410/v1 ◽

2020 ◽

Author(s):

Jiangtao Liu ◽

Hongming Ji ◽

Gangli Zhang ◽

Shengli Chen ◽

Shiyuan Zhang ◽

...

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Anterior Approach ◽

Craniovertebral Junction ◽

Close Proximity ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Surgical Corridor ◽

High Cervical ◽

Neurovascular Structures

Abstract Objectives: Surgery on the craniovertebral junction (CVJ) presents particular challenges owing to the close proximity of critical neurovascular structures and the brainstem. It is difficult for classic approaches to obtain the extra exposure of neurovascular structures of the CVJ in practice.The surgical approach to the craniovertebral junction (CVJ) offers specific challenges. We explored the feasibility of an endoscope-assisted high anterior cervical approach to the CVJ. Methods: We quantitatively assessed the surgical corridor to, and extent of exposure of, the CVJ in six cadaveric specimens, using 0° and 30° endoscopes. Results: The endoscope provided sufficient exposure of neurovascular structures and the brainstem in the CVJ. Resection of the anterior arch of C1 was avoided in minimal anterior clivectomy. After removing the odontoid, greater exposure of the CVJ was obtained. Conclusion: An endoscope-assisted high anterior cervical approach to the CVJ preserves cervical spine stability while minimizing the risk of neurovascular injury within the surgical corridor.

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The Anterior Cervical Approach for Traumatic Injuries to the Cervical Spine in Children

Clinical Orthopaedics and Related Research ◽

10.1097/00003086-199307000-00018 ◽

1993 ◽

Vol 292 ◽

pp. 144-150 ◽

Cited By ~ 32

Author(s):

ITZHACK SHACKED ◽

ZVI RAM ◽

MOSHE HADANI

Keyword(s):

Cervical Spine ◽

Traumatic Injuries ◽

Cervical Approach ◽

Anterior Cervical Approach

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Management of C2-C3 fracture subluxation by anterior cervical approach and C2-C3 trans-cortical screw placement

Romanian Neurosurgery ◽

10.2478/romneu-2018-0023 ◽

2018 ◽

Vol 32 (1) ◽

pp. 170-173

Author(s):

Amit Agrawal

Keyword(s):

Cervical Spine ◽

Morbidity And Mortality ◽

Screw Placement ◽

Upper Cervical Spine ◽

Cervical Spine Injuries ◽

Cortical Screw ◽

Spine Injuries ◽

Upper Cervical ◽

Cervical Approach ◽

Anterior Cervical Approach

AbstractCervical spine injuries are the major cause of morbidity and mortality in trauma victims. Upper cervical spine injuries account for about 24% of acute fractures and dislocations and one third of fractures occur at the level of C2, while one half of injuries occur at the C6 or C7 levels. In contrast to this approach we used the transverse cervical, platysma splitting incision at a lower (C3-C4 disc) to expose the upper cervical spine particularly lower border of C3 (entry point for the screw).

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Chordoma of the Cervical Spine

Neurosurgery ◽

10.1227/00006123-198109000-00006 ◽

1981 ◽

Vol 9 (3) ◽

pp. 253-256 ◽

Cited By ~ 12

Author(s):

Raj Murali ◽

Richard L. Rovit ◽

M. Vallo Benjamin

Keyword(s):

Cervical Spine ◽

Interbody Fusion ◽

Biological Behavior ◽

Diagnostic Feature ◽

Halo Vest ◽

Postoperative Radiation Therapy ◽

Vertebral Involvement ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Radical Removal

Abstract Etight cases of chordoma limited to the cervical spine are presented. The radiological features are analyzed. Although there is no single diagnostic feature, the combination of osteosclerosis and lysis, multiple vertebral involvement, and the presence of a pre- or paracervical mass is strongly suggestive of a chordoma. Although none of our patients can be considered cured, we recommend an anterior cervical approach with radical removal of the tumor and interbody fusion followed by immobilization in a halo vest and postoperative radiation therapy. The biological behavior of the tumor is extremely variable, and multiple operations for symptomatic recurrences may be helpful.

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High anterior cervical approach to the upper cervical spine

Surgical Neurology ◽

10.1016/j.surneu.2006.11.070 ◽

2007 ◽

Vol 68 (5) ◽

pp. 519-524 ◽

Cited By ~ 50

Author(s):

Seong-Hyun Park ◽

Joo-Kyung Sung ◽

Sun-Ho Lee ◽

Jaechan Park ◽

Jeong-Hyun Hwang ◽

...

Keyword(s):

Cervical Spine ◽

Upper Cervical Spine ◽

Upper Cervical ◽

Cervical Approach ◽

Anterior Cervical Approach

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Surgical treatment of degenerative cervical spine diseases: Analyses of 90 patients clinical study

Acta chirurgica iugoslavica ◽

10.2298/aci1203061m ◽

2012 ◽

Vol 59 (3) ◽

pp. 61-68

Author(s):

M. Markovic ◽

N. Zivkovic ◽

D. Stojanovic ◽

M. Samardzic

Keyword(s):

Cervical Spine ◽

Surgical Approach ◽

Iliac Crest ◽

Cervical Disc ◽

Cervical Spine Surgery ◽

Clinical Series ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Cervical Plating ◽

Degenerative Cervical Spine

The effect of degenerative cervical spine surgery depends on good understanding of the pathogenesis and clinical course of disease with a detailed neurological and neuroradiological examination. Surgical approach should be considered separately for each pathological substrate in order to avoid additional morbidity. The aim of our study is to present the results of treatment through analysis of large clinical series focusing on anterior surgical approach with iliac crest graft fusion without cervical plating. The retrospective analysis of 90 patients operated on Neurosurgery of CHC Zemun, from 2008 to 2011, was done. In 81 patients cervical disc herniation was found in one or two levels, and 9 patients had spinal canal stenosis with polydiscopathy. Preoperatively 50 patients had cervical myelopathy, and 40 patients had radiculopathy as dominating clinical sign. Anterior cervical approach was performed in 79 patients, and 11 patients were operated by posterior approach. The treatment outcome was as follows: good outcome 16 (16.8%) patients, improved condition 65 (72.2%), without improvement 6 (6.7%), bad outcome 3 (4.3%). The anterior cervical approach with iliac crest autologous graft fusion, and without additional cervical plating, is reliable treatment option with results comparable to reported clinical series with sintetic graft placement and anterior cervical plate stabilisation.

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Vocal Fold Paralysis following the Anterior Approach to the Cervical Spine

Annals of Otology Rhinology & Laryngology ◽

10.1177/000348949610500201 ◽

1996 ◽

Vol 105 (2) ◽

pp. 85-91 ◽

Cited By ~ 115

Author(s):

James L. Netterville ◽

Michael J. Koriwchak ◽

Mark S. Courey ◽

Mark Winkle ◽

Robert H. Ossoff

Keyword(s):

Cervical Spine ◽

Vagus Nerve ◽

Vocal Fold ◽

Geometric Analysis ◽

Vocal Fold Paralysis ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Recurrent Laryngeal Nerves ◽

The Right ◽

Lost To Follow Up

The anterior cervical approach is commonly used for access to the cervical spine. Vocal fold paralysis (VFP), a complication of this approach, is underrepresented in the literature. A review of the database of the Vanderbilt Voice Center revealed 289 patients with VFP, including 16 patients who developed paralysis as a result of an anterior cervical approach. The paralysis was on the right side in all but 1 patient. Compared to patients who developed VFP after thyroidectomy and carotid endarterectomy, patients with VFP after an anterior cervical approach have a higher incidence of aspiration and dysphagia, suggesting the presence of trauma to the superior laryngeal and pharyngeal branches as well as the recurrent branch of the vagus nerve. Two patients had partial return and 1 patient had complete return of vocal fold movement within 10 months. Of the remaining 13 patients, 8 underwent vocal fold medialization with improvement of symptoms. Two patients are 6 and 7 months postinjury and await vocal fold medialization. Two patients are 27 months and 45 months postinjury and are considering vocal fold medialization. The remaining patient was lost to follow-up. An anatomic-geometric analysis of the right and left recurrent laryngeal nerves was performed by using measurements obtained from computed tomography scans of 8 patients with idiopathic unilateral VFP, as well as experience gained through surgical and cadaveric dissections. We conclude 1) the anterior cervical approach may place multiple branches of the vagus nerve at risk; 2) because of anatomic-geometric factors, die right-sided anterior cervical approach may carry a greater risk to the ipsilateral recurrent laryngeal nerve than does the left; and 3) an understanding of the anatomy and geometry presented herein allows relatively safe exposure from either side of the neck.

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Microsurgical Resection of an Intramedullary Spinal Cord Hemangioblastoma Through an Anterior Cervical Approach: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opaa314 ◽

2020 ◽

Author(s):

Kyle Lindsey McCormick ◽

Nikita Alexiades ◽

Paul C McCormick

Keyword(s):

Spinal Cord ◽

Tumor Resection ◽

Residual Tumor ◽

Complete Recovery ◽

Surgical Removal ◽

Intramedullary Spinal Cord ◽

Dural Closure ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Microsurgical Resection

Abstract This video demonstrates the microsurgical removal of an intramedullary spinal cord hemangioblastoma through an anterior cervical approach. While most spinal hemangioblastomas arise from the dorsal or dorsolateral pial surface and can be safely resected through a posterior approach,1,2 ventral tumors can present a significant challenge to safe surgical removal.3-5 This patient presented with a progressively symptomatic ventral pial based hemangioblastoma at the C5-6 level with large polar cysts extending from C3 to T1. The tumor was approached through a standard anterior cervical exposure with a C5 and C6 corpectomy. Following midline durotomy, the tumor was identified and complete microsurgical resection was achieved. The principles and techniques of tumor resection are illustrated and described in the video. Following tumor resection and dural closure, a fibular allograft was inserted into the corpectomy defect and a C4-C7 fixation plate was placed. The patient was maintained in a supine position for 36 h. He was discharged home on postoperative day 3 in a cervical collar. The patient did well with near-complete recovery of neurological function. Postoperative magnetic resonance imaging at 6 wk showed a substantial resolution of the polar cysts and no evidence of residual tumor. The patient featured in this video consented to the procedure.

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A microsurgical anterior cervical approach and the immediate impact of mechanical retractors: A case control study

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.158748 ◽

2015 ◽

Vol 6 (03) ◽

pp. 315-319 ◽

Cited By ~ 4

Author(s):

Rodrigo Ramos-Zúñiga ◽

Laura Rocío Díaz-Guzmán ◽

Shannen Velasquez ◽

Ana Magdalena Macías-Ornelas ◽

Martín Rodríguez-Vázquez

Keyword(s):

Soft Tissue ◽

Case Control Study ◽

Case Series ◽

Soft Tissue Injuries ◽

Radical Change ◽

Case Control ◽

Retrospective Case ◽

Cervical Approach ◽

Anterior Cervical Approach ◽

Control Study

Abstract Introduction: A microsurgical anterior cervical approach with discectomy and fusion (MACDF) is one of the most widely used procedures for treating radicular disorders. This approach is highly successful; however, it is not free from complications. These can be associated with soft tissue injuries. Aim of the Study: The recognition of the risks for these complications should be identified for timely prevention and safe treatment. Materials and Methods: Study Design: Retrospective case control study. This study includes a retrospective case series of 37 patients, paying special attention to immediate complications related to the use of mechanical retraction of soft tissue (dysphagia, dysphonia, esophageal lesions and local hematoma); and a comparative analysis of the outcomes after changes in the retraction method. Results: All selected cases had a positive neurological symptom response in relation to neuropathic pain. Dysphagia and dysphonia were found during the first 72 h in 94.1% of the cases in which automatic mechanical retraction was used for more than one hour during the surgical procedure. A radical change was noted in the reduction of the symptoms after the use of only manual protective blades without automatic mechanical retraction: 5.1% dysphagia and 0% dysphonia in the immediate post-operative period, P = 0.001. Conclusions: Soft tissue damage due to the use of automatic retractors in MACDF is not minor and leads to general discomfort in the patient in spite of good neurological results. These problems most often occur when automatic retractors are used continuously for more than 1 hour, as well as when they are used in multiple levels. Dysphagia, dysphonia and local pain decreased with the use of transient manual blades for retraction, and with intermittent release following minimally invasive principles.

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