Far Lateral Approach to the Cervical Spine

5 Far Lateral Approach to the Cervical Spine

Christopher J. DeWald

Goals

Decompress the anterolateral cervical spine with complete and safe extensive exposure.

Indications

1. Anterolateral disc herniations

2. Tumors of the cervical spine

3. Nerve compression due to lateral osteophytes

Contraindications

1. Midline or strictly posterior pathology.

2. Vertebral artery disease.

Advantages

1. Exposure of the vertebral artery.

2. Exposure of the neuroforamen.

3. Exposure of the nerve root.

4. The key to this approach is safe identification and exposure of the vertebral artery. The vertebral artery is much less likely to be injured during an anterior lateral approach of the cervical spine if it has already been exposed.

Procedure

1. The skin incision is made in the standard transverse fashion.

2. The platysma muscle is split longitudinally or incised in line with the skin incision.

3. The cervical fascia is sharply dissected medially to the sternocleidomastoid muscle and the medial visceral structures.

4. The pretracheal fascia in then bluntly divided longitudinally along the carotid sheath separating it from the visceral structures medially.

5. Carotid pulsations are checked to identify the carotid artery and ensure that there is not excessive pressure against the artery during retraction for the exposure.

6. Ipsilateral temporal artery pulsations can also be palpated during exposure to help prevent excessive arterial constriction.

7. The prevertebral fascia is incised longitudinally in the midline of the vertebrae and the longus coli muscles are stripped laterally off the anterior aspect of the cervical spine.

8. Carefully, the surgeon continues dissecting the muscles from the lateral aspect of the cervical vertebrae, its uncovertebral joints, and onto the transverse processes (Fig. 5–1). The vertebral artery lies just anterior to the nerve root as the nerve root exits its foramen. Careful dissection onto the transverse process is required not to injure the nerve root or vertebral artery by slipping posterior to the transverse process. Often, when the longus coli muscle is large, it has to be incised transversely a few millimeters directly on top of the transverse process. Care should be taken not to injure the cervical sympathetic chain as it lies further lateral in this approach, especially when incising the longus coli muscle in a transverse fashion.

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