Direct Drop-Down Anterior Approach to Subaxial Cervical Spine

Abstract

Background: Subaxial cervical spine comprises C3-C7 levels. Southwick and Robinson’s is most commonly used surgical approach for subaxial cervical spine. We are describing a new technique of approaching cervical vertebrae using same planes as in classical approach by Southwick and Robinson. Material and Methods: A total of 35 cases with cervical spine pathologies requiring anterior cervical approach were included in the study. Patients requiring posterior based surgeries, >2-disk level anterior exposure and with history of any previous anterior based cervical spine surgery were excluded from the study. Surgical Technique: The patients were positioned supine on operating table. A 3 cm transverse skin incision is given starting from midline and extending laterally at desired vertebral level. Langenbeck’s retractor of appropriate size is used by surgical assistant to apply gentle constant lateral traction on trachea. The esophagus being invaginated by same pretracheal layer of deep cervical fascia, moves along with trachea. Soft tissue is bluntly dissected with peanut sponge. Steps are repeated till vertebra is reached. Result: Of the 35 cases included in the study, maximum cases (19) were traumatic cervical spine fractures. The average surgical time, intraoperative blood loss in negative suction drains, postoperative hospital stays in this group of cohort was similar to the cohort in which typical traditional approach was used. Discussion: Perceived advantages include—smaller skin incision, less chances to damage carotid sheath and its contents, safe, easy and less time-consuming technique, cosmetically better due to smaller incision size along Langer’s lines.