Relevant Surgical Anatomy of the Anterior Cervical Spine, the High Retropharyngeal and the Subaxial Regions
In the present chapter, the relevant anatomic structures of the anterior neck and the anterior cervical spine are discussed, related to the high retropharyngeal and the anterior subaxial approaches. The relevant muscles, fasciae, vessels, and nerves are s
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Relevant Surgical Anatomy of the Anterior Cervical Spine, the High Retropharyngeal and the Subaxial Regions Gergely Bodon and Andres Combalia
The anterior approach to the cervical spine allows for exposure of the ventral aspect of the vertebral bodies, discs, ipsilateral transverse foramens, and the vertebral artery. In the present chapter, the relevant anatomic structures of the anterior neck and the anterior cervical spine are discussed, related to the high retropharyngeal and the anterior subaxial approaches. To perform a safe exposure of the anterior cervical spine, familiarity with the components of the carotid sheath, the lower four cranial nerves and their branches, as well as the five fascial layers covering all the structures of the neck is of paramount importance. Figure 7.1 demonstrates the principles of the standard anterior subaxial approach. The spine is reached by opening five subsequent fascial layers covering the structures of the anterior neck (Fig. 7.1a), while the sternocleidomastoid muscle with the underlying carotid sheath and its contents are retracted laterally; the esophagus, trachea, and larynx with the infrahyoid muscles are retracted medially (Fig. 7.1b).
G. Bodon (*) Department of Orthopaedic Surgery, Klikikum Esslingen, Esslingen a.N., Germany A. Combalia Department of Orthopaedic Surgery, Musculoskeletal Oncology Unit, Hospital Clinic Universitari de Barcelona, School of Medicine, Barcelona, Spain
Muscles of the Anterior Neck The topographic anatomy of the anterior neck is shown on Fig. 7.2. The most prominent muscle of the anterior neck is the sternocleidomastoid muscle originating from the manubrium of the sternum and the medial third of the clavicle. It traverses the neck running posterolateral to insert on the mastoid process and the lateral part of the occipital bone; it is innervated by the accessory nerve and the ventral ramuses of C2 and C3 [1]. The great auricular nerve, the branches of the external jugular vein, and the cutaneous cervical nerve cross the anterior surface of this muscle (Fig. 7.3). The deeper muscles of the anterior neck are divided to suprahyoid and infrahyoid muscles. The most superficial of the infrahyoid muscles is the omohyoid muscle. The inferior belly arises from the scapular notch, turns anteromedially and ends in the intermediate tendon which lies on the internal jugular vein at the level of the cricoid cartilage. The superior belly of the omohyoid muscle runs cranially and medially to the lower border of the hyoid bone. The superior belly is encountered when operating at the C5– C6 and C6–C7 levels at the anterior margin of the sternocleidomastoid muscle. Medial to the superior belly is the sternohyoid muscle ascending cranially from the posterior surface of the manubrium to the hyoid bone. Deep and lateral to the sternohyoid muscle are the sternothyroid (running from the posterior surface of the manubrium
© Springer Nature Switzerland AG 2019 H. Koller, Y. Robinson (eds.), Cervical Spine Surgery: Standard and Advanced Techniques, https://doi.
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