Planning and positioning
- •
Preoperative imaging is essential to identify pathology and verify the corresponding vertebral level.
- •
Useful tools include loupes and possibly an operating microscope.
- •
If the decision has been made for iliac crest autograft, the hip should be prepared and draped.
Figure 59-1:
Position the patient supine with the bed in a slight reverse Trendelenburg position. Place an inflatable cushion between the scapulae. Consider using monitoring before and after positioning if myelopathy is present.
- •
Wrap arms in gel pads to protect the ulnar nerve. Secure the patient to the table with tape and seat belt.
Figure 59-2:
Use anatomic landmarks to determine the cervical level; the thyroid cartilage localizes C4-5, and palpation of the carotid tubercle localizes the C6 level. If it is difficult to ascertain the level accurately, mark the incision slightly superior to the estimated level of pathology; it is easier to expose inferiorly than superiorly.
Procedure
Make a transverse skin incision. Incise the platysma to expose the deep cervical musculature. Use bipolar electrocautery to maintain hemostasis. Develop the avascular plane. Use blunt dissection in this plane to expose the vertebral bodies. Dissect the longus colli muscle to the prevertebral fascia laterally using blunt techniques.
Related posts:
Stay updated, free articles. Join our Telegram channel
Full access? Get Clinical Tree
