Anterior approach to the Cervical Spine

Place appropriately prepared patient supine on operating table with a Mayfield headrest
Administer IV antibiotics
Turn head away from side of approach, usually towards right
Elevate table 30°
- decreases venous bleeding
Prepare skin & drape patient, exposing neck from jaw to jugular notch

Transverse incision at level of fusion
From posteriorly border of SCM to midline
- It is possible to access up three levels via one transverse incision, but if wider access is required, less cosmetically pleasing incision can be made along anterior border of sterncleidomastoid

Divide fascia over platysma in line with skin incision
Split fibres of platysma in their line using blunt dissection
Locate SCM (spinal accessory nerve)
- & divide fascia along its anterior border, retract SCM laterally
Retract strap muscles medially (segmental innervation)
- Sternohyoid
- Sternothyroid
Locate carotid sheath, & divide pretracheal fascia along medial aspect of sheath
- Common carotid artery
- Vein
- Vagus nerve
Retract carotid laterally
Retract midline structures medially
- trachea & oesophagus & thyroid gland
Dangers
- superior & inferior thyroid arteries
  - connect the carotid sheath to midline structures
- middle thyroid vein
- These may be divided if required

Cervical vertebrae are visible covered by
- Anterior longitudinal ligament
- Longus colli muscle
- sympathetic chain
- Prevertebral fascia
Divide prevertebral fascia vertically, in midline down to bone
Reflect subperiosteally
- prevertebral muscles & sympathetic chain & ALL
- to expose to anterior vertebral body

Nerves
- Recurrent laryngeal nerve
  - Right
    - may cross transversely
  - Left
    - Nerve is more constant in its course
  - May be damages during deepest layer of approach
- Sympathetic nerves & stellate ganglion
  - Horner’s syndrome
Vessels
- Carotid sheath & contents
- Vertebral artery
- Superior & inferior thyroid arteries