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Therefore, retraction of the musculovisceral column exposes the nerve to less tension on the left than on the right side [17, 47, 53]. Too far lateral exposure under the longus colli may jeopardize the ver tebral artery, which usually enters the cervical spine at C6 [16, 57, 71]. The sym pathetic trunk lies in the prevertebral fascia in front of the longus colli muscles and can be injured when stripped off the longus colli muscle to dissect the verte Damage to the sympathetic brae and discs (Fig. Wound Closure the anterolateral approach is an anatomical approach achieved mainly by blunt Always use prevertebral dissection, which facilitates wound closure. Such a hema toma can rapidly compress the trachea and make reintubation of the patient impossible. Therefore, a prevertebral suction drainage is mandatory, which needs to be sutured to avoid the loss of the drainage during transfer. Therefore, we recommend using an image intensifier for 342 Section Surgical Approaches Identify and regularly level localization. Therefore, the pulse of this artery must be palpated to ensure that the artery is indeed lateral. Complete recovery of vocal cord function was documented in 26 (93%) of 28 patients who had undergone a thyroidectomy [46]. Posterior Approach to the Cervical Spine the anterior and posterior approaches are both frequently used to approach the cervical spine in a variety of disorders [58]. Indications the posterior approach to the cervical spine is predominantly indicated in cases with multisegmental degenerative changes or with craniocervical disorders (Table 2): Table 2. This fixation avoids pressure sores on the face, which are not infrequent when using other types of headrest. A footrest allows the whole table to be tilted head up, which accommodates the surgical approach. When a short level exposure is attempted, image intensifier control is recommended to avoid unnecessary detachment of the posterior spinal muscles (Fig. Superficial Surgical Dissection After skin incision and splitting of the subcutaneous tissue, the superficial surgi cal dissection should first identify the nuchal ligament. In some patients, heavy bleeding is encountered which has to be borne in mind when performing this approach. Dense packing of the space between the spinous process and the laterally retracted muscles helps to control the bleeding. During the superficial dissection Surgical Approaches Chapter 13 345 care has to be taken not to injure the greater occipital nerve (Fig. Deep Surgical Dissection For exposure of the craniocervical junction, it is recommended to osteotomize with a chisel (or oscillating saw) the muscle insertion of the deep muscle layer from the spinous process of C2 (Fig.

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