Surgical approaches

Surgical exposure of the upper cervical spine is considered difficult and dangerous because of the anatomical complexity, deep location, proximity to vital neurovascular structures. These approaches to the spine generally are performed by an experienced spine surgeon and, as a rule, this type of surgery is not appropriate for those who only occasionally perform spinal techniques. A team approach is preferred to use the skill of the orthopaedic surgeon, neurosurgeon, thoracic surgeon and head and neck surgeon. The orthopaedics still must have a working knowledge of the underlying viscera. The choice of approach depends on surgical indications, the preference and experience of the surgeon, the patient's age and medical condition, the segment of the spine involved, the underlying pathological process and the presence or absence of sign of neural compression. Adequate planning should be performed prior to the incision.