Simplified four-step retropharyngeal approach for the upper cervical spine: technical note
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ORIGINAL ARTICLE
Simplified four‑step retropharyngeal approach for the upper cervical spine: technical note Pasquale De Bonis1 · Antonio Musio1 · Giorgio Mantovani1 · Angelo Pompucci2 · Jacopo Visani1 · Giorgio Lofrese3 · Alba Scerrati1 Received: 14 March 2020 / Revised: 26 May 2020 / Accepted: 23 June 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Purpose In this paper, we propose a simplified four-step retropharyngeal approach, whose aim is getting straight to the upper cervical spine minimizing complications. Methods While the classical retropharyngeal approach includes about 11 steps, ours is a four-step approach: patient positioning, skin-platysma incision, hyoid bone superolateral dissection and retropharyngeal blunt exposure. We avoid several steps of the classical anterior retropharyngeal approach, particularly dissection of submandibular gland, facial veins, external carotid artery and thyroid artery, bellies of the digastric muscle, hypoglossal nerve, thyrohyoid membrane and the internal branch of superior laryngeal nerve. Results We have adopted this technique for five patients: two patients had a C2–C3 herniated disk with myelopathy, two patients had unstable Hangman fracture with no bone fusion after 2-month treatment with rigid collar, and one patient had a C2–C3 osteophyte with dysphagia. The intraoperative time needed for reaching the retropharyngeal space was 15 (first case), 9 (second case), 7 min (third case—illustrative case—and fourth case), 8 min (fifth case). No complications occurred. Conclusion Our simplification, avoiding several steps, is simple, effective, safe, and rapid and requires a simple learning curve. Keywords Retropharyngeal approach · Upper cervical spine · Submandibular approach
Introduction The retropharyngeal approach allows for surgical access to the upper spine. Two variations of the retropharyngeal approach to the upper cervical spine have been described: lateral and anterior approach. The lateral retropharyngeal approach was described by Whitesides and Kelly as an upper Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00586-020-06521-5) contains supplementary material, which is available to authorized users. * Antonio Musio [email protected] 1
Department of Neurosurgery, Sant’Anna University Hospital, Viale Aldo Moro 8, 44124 Ferrara, Italy
2
Department of Neurosurgery, Santa Maria Goretti Hospital, Latina, Italy
3
Department of Neurosurgery, Maurizio Bufalini Hospital, Cesena, Italy
cervical spine corridor lateral to the carotid sheath. This approach does not provide a midline view, making midline decompression and strut grafting difficult. Moreover, the ipsilateral vertebral artery lies in the approach corridor [27, 28]. The anterior variation was initially described by de Andrade and MacNab [3] and Southwick and Robinson [24]. Later, McAfee and associates modified it, allowing for a wider midline exposure [14]. The McAfee approach is made of several steps (about 11),
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