Anterior approach to the cervical spine: Elegance lies in its simplicity

Abstract

Introduction: Since the landmark publication by Smith and Robinson, approaches to the cervical spine anteriorly have undergone many modifications and even additions. Nevertheless, at its core, the anterior approach remains an elegant and efficient approach to deal with majority of cervical spine pathologies including the degenerative cervical spine. Methodology: For this review, we searched for all major cases series and randomized control trials of anterior cervical approaches using the PubMed databases. Articles having the details of clinical variables and outcomes were tabulated and analyzed. Results: A total of 9 case series for transoral, 7 case series for transmanubrial, 19 case series for anterior cervical discectomy and fusion (ACDF), 6 studies for ACDF versus posterior cervical foraminotomy, 37 case series for ACDF versus arthroplasty, and 7 studies for ACDF versus anterior cervical corpectomy and fusion have been included. The majority of the case series suggested that the anterior cervical procedures have good clinical outcomes. The upper cervical spine approached by the transoral route had good outcomes in ventral compressive pathologies, with morbidity of cerebrospinal fluid leak in 7% of patients. The midcervical spine approached by ACDF had better clinical outcomes equivalent to the majority of modifications even in multiple-level pathologies. The transsternal approach had provided greater access and stability to the cervicothoracic junction with minimal morbidity. Conclusion: The anterior cervical approach can address the majority of cervical pathologies. They provide adequate corridor from craniovertebral junction to T4 with minimal morbidity, thus providing a good clinical outcome.

Right transmanubrial approach to the cervicothoracic spine with venous reconstruction

“…Meticulous dissection and retractions of the right and left brachiocephalic vessels in various directions are required to explore the potential spaces for adequate instrument handling in the deep surgical field. 4 In the present case with prior median sternotomy, the right brachiocephalic artery and vein were major obstacles to approaching the cervicothoracic spine safely. Although the transclavicular approach, which requires the removal of the manubrium sterni and one-third of the medial clavicle in one piece, is relatively well-tolerated, maintaining sternoclavicular joint integrity may be a key factor for better neurological outcomes with good upper limb stability.…”

Impact of Implant Size and Position on Subsidence Degree after Anterior Cervical Discectomy and Fusion: Radiological and Clinical Analysis

“…Through the strategic implantation of material into the affected disc space, we are able to generate the requisite conditions for fusion to take place. This process stabilizes the impacted segment and effectively mitigates the potential for disease progression [2][3][4]. Recent advancements in materials technology have led to a shift away from the traditional use of iliac grafts in medical procedures.…”

Commentary: Trans-Sternal Multilevel Corpectomy for Cervicothoracic Renal Cell Metastasis: 2-Dimensional Operative Video

“…The morbidity of a sternal split can be avoided through a trans-manubrium only approach while still gaining access from C7 to T4. 2 Alternatively, a partial sternotomy or trans-upper-sternal approach can be considered. 3 The authors placed an expandable cage, understandably, because these are technically easier to place than autograft options.…”