Surgical approach: Anterolateral high cervical approach

Abstract

Anterior approach of high cervical spine particularly occipito-cervical area and atlanto-axis vertebrae remains a demanding surgery. Occipito-cervical junction may be involved in different pathologies: inflammatory, tumours, malformation, degenerative alteration. Sometimes only the anterior part of the spine must be reached. Mobilization of the vertebral artery (VA) must be done. A perfect knowledge of the anatomy is necessary, particularly the course of the vertebral artery and its anomalies. Surgical Technique: The technique is the same as described for the high anterior approach of the vertebral artery which must be mobilized by resection of the transverse process of C1 and C2. The approach is anterior to the sternocleidomastoid muscle but retro-vascular. Mobilization of the VA at C1 and C2 allows a lateral approach of the occiput condyle, C1 lateral mass, C2 vertebral body and O-C1 and C1-C2 joints. Conclusion: This technique remains demanding, but in some cases no other approach can be used for treating the patient.