Anterior approach to the cervical spine

Abstract

Twenty patients consisting of tuberculosis (6), post-traumatic instability (2), bone tumor (2), spondylotic myelopathy (7), and cervical disc prolapse (3) were reviewed. 18 patients at the time of operation had advanced objective neural deficit, 2 of post-traumatic instability had recovered from prior quadriparesis. For localisation in the absence of compatible radiological signs, myelography was considered mandatory. All patients were in skull traction (4-6 weeks) pre-operatively, during operation and post-operatively. While operating in the absence of an obvious mass, lateral operative radiograph localised the site. It was a safe procedure for effective decompression and arthrodesis from the lower border of the second cervical to the first dorsal vertebra. Up to 3 consecutive disc spaces and intervening vertebral bodies could be conveniently tackled. A suitable sized block of bone graft snuggly fitted in the gap with few special instruments, provided a stable fixation. Postoperative skull traction and four-post collar ensured success of arthrodesis in all cases despite subluxation of the graft in 2 patients. Neurological deficit recovered in all except 2 with generalised radiological cervical spondylosis.