Introduction: Since the landmark publication by Smith and Robinson, approaches to the cervical spine anteriorly have undergone many modifications and even additions. Nevertheless, at its core, the anterior approach remains an elegant and efficient approach to deal with majority of cervical spine pathologies including the degenerative cervical spine. Methodology: For this review, we searched for all major cases series and randomized control trials of anterior cervical approaches using the PubMed databases. Articles having the details of clinical variables and outcomes were tabulated and analyzed. Results: A total of 9 case series for transoral, 7 case series for transmanubrial, 19 case series for anterior cervical discectomy and fusion (ACDF), 6 studies for ACDF versus posterior cervical foraminotomy, 37 case series for ACDF versus arthroplasty, and 7 studies for ACDF versus anterior cervical corpectomy and fusion have been included. The majority of the case series suggested that the anterior cervical procedures have good clinical outcomes. The upper cervical spine approached by the transoral route had good outcomes in ventral compressive pathologies, with morbidity of cerebrospinal fluid leak in 7% of patients. The midcervical spine approached by ACDF had better clinical outcomes equivalent to the majority of modifications even in multiple-level pathologies. The transsternal approach had provided greater access and stability to the cervicothoracic junction with minimal morbidity. Conclusion: The anterior cervical approach can address the majority of cervical pathologies. They provide adequate corridor from craniovertebral junction to T4 with minimal morbidity, thus providing a good clinical outcome.

Background: Varicocele is the most common cause of male infertility. About 20-30% men with varicocele are infertile. The clinically obvious varicocele is identifiable and correctable cause of male infertility, but less is known about the subclinical varicocele and its relationship to infertility. However, subclinical varicocele seems to be an important cause of infertility and hence scrotal ultrasonography is increasingly used in the diagnosis of subclinical varicocele. This study was undertaken to reveal incidence of subclinical varicocele in patients with severely impaired fertility potential.Objectives: To find the prevalence of subclinical varicocele in subjects of severely impaired fertility potential. Materials and Methods:The semen samples were obtained from 31 male partners (age 25-40 years) of infertile couples (sperm count less than 1 million/ml) attending the OPD Smt. SCL Hospital, Ahmedabad. They were analyzed for routine seminogram parameters. In this study, we evaluated male subjects with severely impaired fertility potential using scrotal ultrasonography, follicle-stimulating hormone, luteinizing hormone, and free testosterone. Results:The subclinical varicocele was present in 12 of 31 infertile male subjects evaluated. Percentage prevalence of subclinical varicocele was observed to be 39%. Hormonal levels of all the subjects studied were within normal limit. There was no significant difference in testicular volume of affected side and contralateral side of infertile male subjects.Conclusion: Scrotal ultrasonography is an important technique to reveal the subclinical varicocele for early diagnosis and management of these infertile male subjects.