Cervical spine anatomy
- 7 cervical vertebrae
- 8 cervical nerve roots—nerve roots exit caudal
neuroforamina (i.e. C8 nerve root caudal to C7 vertebrae)
Anterior approach to the c-spine
- Hyoid bone lies at C3
- Cricoid cartilage/carotid tubercle lies at C6
o carotid tubercle is located on the
anterolateral aspect of C6
o longus capitis and anterior scalene
muscles attach to it;
- Left sided approach—recurrent laryngeal
nerve protected with retraction as it lies
between trachea and esophagus
o Right sided approach generally avoided
due to aberrant course of recurrent
laryngeal nerve
o Recurrent laryngeal nerve injury—
hoarsness if unilateral, breathing
difficulties and aphonia if bilateral
- Surgical Approach:
o transverse incision from the anterior
edge of the SCM muscle to just shy of
midline
o incision is carried down to the platysma
muscle/fascia
o Incise platysma in line with incision
o Palpate the carotid artery in carotid sheath
 Carotid sheath—carotid artery, internal jugular vein, vagus
nerve—lateral to dissection
o Blunt dissection posteriorly and medially to vertebral body
o Retract SCM and carotid sheath laterally;
sternohyoid, sternothyroid, esophagus and
trachea medially after incising pretracheal
fascia
o Protect esophagus, trachea and recurrent
laryngeal nerve
 Beware at C3-4 of transverse crossing
superior thyroid artery
 Beware of inferior thyroid artery at level
of C7 as it branches off thyrocervical trunk
and crosses towards midline
o The anterior edge longus coli muscle is gently
mobilized along both sides of the disc space
o Sympathetic chain lies on the longus coli muscle
lateral to vertebral bodies
 Horner’s syndrome—miosis, ptosis,
anhydrosis due to damage of sympathetic
nerves and stellate ganglion
Posterior approach to the spine
- C2 and C7 or T1 are the most prominent spinous processes
- Midline incision centered over C2-C7
- Ligamentum nuchae (midline) and trapzius (lateral) encountered first
- Internervous plane between paracervical spinous musculature— splenius
capitis, splenius capitis, semisplenalis capitis, splenius cervicus,
semispinalis cervicis, multifidus muscles
- Dissect down either side of spinous process at desired level to lamina
- Carry out dissection laterally to facets and beginning of transverse
processes (beware of vertebral artery running through TP)
- Perform laminectomy to identify the ligamentum flavum
- Expose dura and exiting nerve roots