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Anterior Approach to the Cervical Spine

- PreOp Planning:
     - consider NG tube and foley catheter;
     - have proper sized C-collar available for post operative care;
     - position: supine w/ halter cervical traction (3-5 lbs) w/ head turned slightly to the right;
           - consider placing a rolled towel between the shoulder blades;
     - prep for iliac crest bone graft;
     - hall burr is helpful for shaping bone graft;

- Anatomy:
    - hyoid cartilage: lies at the level of C3;
    - carotid tubercle:
         - carotid tubercle is located on the anterolateral aspect of C6;
         - longus capitis and anterior scalene muscles attach to it;
    - cricoid cartilage: lies at the level of C6;
    - vascular structures:
         - inferior thyroid artery course horizontally toward midline as branch as branch of thyrocervical trunk at the level of C7;
         - carotid sheath (containing carotid artery, internal jugular vein, and the vagus nerve) lie lateral to the dissection;
         - vertebral arteries lie posteriorly, and can be injured w/ anterior approach;
    - nerves:
         - right sided surgical approaches to the cervical spine are generally avoided in order to avoid the aberrant course of the recurrent 
                 laryngeal nerve;
         - left recurrent laryngeal nerve, is protected during the dissection as it runs between the trachea and the esophagus;
         - cerival sympathetic chain:
                 - is located anterior to the longus capitis muscle and lateral to the longus coli;
    - thoracic duct:
         - lies on the left side, lateral to the esophagus;
         - at the level of T1, it passes anterior to the anterior scalene muscle, loops around the subclavian artery, and enters the subclavian vein;
         - when exposure at this level is required, consider a right sided approach;

- Positioning:
    - supine, posterior interscapular role, and Halter traction (5 lbs);

- Surgical Approach:
    - transverse incision from the anterior edge of the sternocliedomastoid muscle to a point just shy of the midline;
    - incision is carried down to the platysma muscle and fasci;
           - metzenbaum scissors are used to bluntly dissect beneath the platysma muscle and are used to elevate 
                  the platysma;
           - platysma muscle is incised in line with the incision;
    - carotid artery is palpated and protected;
    - blunt dissection then procedes posteriorly and medially to the midline of the vertebral body;
    - the disc space is identified;
    - the anterior edge longus coli muscle is gently mobilized laterally along both sides of the disc space;
           - bleeding may be encountered if the dissection proceeds towards the center of the vertebral body;

- Anterior Arthrodesis of Cervical Spine

The anterior cervical approach for traumatic injuries to the cervical spine in children.

The anterior retropharyngeal approach to the upper part of the cervical spine.

Modified anterior approach to the cervicothoracic junction.