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

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 pat...

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Published in:Asian journal of neurosurgery Vol. 16; no. 4; pp. 669 - 684
Main Authors: Arumalla, Kirit, Bansal, Hanish, Jadeja, Jigarsingh, Batish, Aman, Deora, Harsh, Tripathi, Manjul, Mohindra, Sandeep, Behari, Sanjay
Format: Journal Article
Language:English
Published: A-12, 2nd Floor, Sector 2, Noida-201301 UP, India Thieme Medical and Scientific Publishers Pvt. Ltd 01.10.2021
Wolters Kluwer India Pvt. Ltd
Medknow Publications and Media Pvt. Ltd
Wolters Kluwer - Medknow
Subjects:
Health aspects
Neurosurgeons
Spine
Surgery
Systematic Review
Systematic Review Article
Training
Vertebrae, Cervical
India
corpectomy
cervical spine
cervical spondylotic myelopathy
Anterior cervical approach
ISSN:1793-5482, 2248-9614
Online Access:Get full text
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Summary: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.
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ISSN:1793-5482
2248-9614
DOI:10.4103/ajns.AJNS_313_20