The Journal of Bone and Joint Surgery, Vol 69, Issue 9 1371-1383, Copyright © 1987 by Journal of Bone and Joint Surgery, Inc
The anterior retropharyngeal approach to the upper part of the cervical spine
PC McAfee, HH Bohlman, LH Riley, RA Robinson, WO Southwick and NE Nachlas
Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205.
Since 1959, we have used a superior extension of the anterior approach to
the cervical spine of Robinson and Smith in a consecutive series of
seventeen patients. This approach provided anterior access to the neural
elements from the clivus to the body of the third cervical vertebra,
without the need for posterior dissection of the carotid sheath or entrance
into the hypopharynx or oral cavity. It also provided adequate exposure for
the insertion of iliac or fibular strut grafts, which was necessary in
thirteen patients. The approach gave excellent exposure for anterior
intralesional excision of a tumor in ten patients, marginal excision of an
osteochondroma, two corpectomies of the second cervical vertebra combined
with removal of the odontoid process, corpectomy of the second cervical
vertebra for the treatment of fixed atlanto-axial subluxation, removal of a
bullet anterior to the clivus, reduction of a dislocation of the second on
the third cervical vertebra secondary to an unstable fracture of the
pedicles of the second cervical vertebra, and anterior debridement for
treatment of pyogenic vertebral osteomyelitis. In contrast to the reported
results of transmucosal approaches to the atlas and axis, there were no
infections or iatrogenic neurological deficits of the spine in the present
series. Twelve patients who were followed for two years or more had a solid
anterior fusion and no subsequent loss of cervical stability. Pain in the
neck was relieved in all of the patients who had had a pathological or
traumatic fracture.
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