Indications

• •
  

  Cervical instability from multilevel anterior cervical diskectomies or corpectomies

  
  
• •
  

  Increase in posterior tension band in patient with kyphotic cervical curve who requires an anterior procedure

  
  
• •
  

  Posterior cervical laminectomy for myelopathy to reduce pathologic motion

Contraindications

• •
  

  Aberrant vertebral artery anatomy

  
  
• •
  

  Lateral mass fracture or lateral mass of inadequate size

Planning and positioning

The patient is positioned prone on chest rolls with Mayfield pin fixation. Preoperative fluoroscopy should be used to confirm proper cervical alignment if lateral mass fixation is part of either occipitocervical fusion or cervicothoracic fusion.

Procedure

Midline incision and paraspinal dissection to expose spinous processes, laminae, and lateral masses of appropriate levels.

The appropriate starting point can be determined by creating an imaginary X over the lateral mass. The superior and inferior boundaries are the facet joints, and the medial and lateral boundaries of the lateral mass serve as the other boundaries. The ideal starting point is 1 mm medial to the middle of the imaginary X .

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