Anterior approaches to the cervical spine

2. C1–3 (upper cervical spine):

a) transoral approach: including odontoidectomy

b) extrapharyngeal approaches: use nasotracheal intubation (so that the mandible can be com- pletely closed) through the contralateral nares. The head is slightly extended and is rotated 15° to the contralateral side.

Avoid any oral tubes

● medial extrapharyngeal approach: medial to carotid sheath. Provides a more anterior position than the lateral retropharyngeal approach. Structures encountered: branches of external carotid artery, upper laryngeal nerves, hypoglossal nerve

● lateral retropharyngeal approach: only the spinal accessory nerve is encountered

3. C3-C7: standard anterior cervical discectomy approach

a) For 1 or 2 level ACD For 1 level corpectomy, a horizontal incision is usually employed

b) For more levels, a vertically oriented incision may be preferred to facilitate access