The High Cervical Anterolateral Retropharyngeal Approach

Alshafai, Nabeel; Gunness, Vimal Raj Nitish

doi:10.1007/978-3-319-62515-7_21

Cited by 10 publications

(10 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…55 This technique appears to enjoy little popularity, with none of the articles included in this study employing it. Authors describing the approach in this systematic review referred to a transverse skin incision at the midpoint between the angle of the jaw and thyroid cartilage 17,32,44,45,56,57 ; others included in this review 18,31 and in the wider literature 58 described a "high retropharyngeal," "submandibular," or "high anterior cervical" approach, which may involve an incision closer to the mandible; others described a more longitudinal skin incision from the angle of the jaw to the hyoid bone. 46,48,49 After skin and platysma incision, all authors used the fascial planes of the neck to retract the sternocleidomastoid and carotid sheath laterally and enter the retropharyngeal space to expose the prevertebral fascia.…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Hangman’s Fracture: A Systematic Review

2023

View full text Add to dashboard Cite

Background: Hangman's fractures are bilateral fractures of the C2 pars interarticularis produced during hyperextension injuries. The Levine-Edwards classification divides these fractures into 4 categories determined by injury stability. While stable fracture patterns are typically managed conservatively, prolonged traction required in unstable fractures may be superseded by surgery in its practicality. Surgical approaches can be divided into anterior and posterior: the anterior approach allows access to the disc and is used for anterior cervical discectomy and fusion (ACDF); the posterior approach includes C2 direct pedicle screw (DPS), which preserves motion segments and may be done with a minimally invasive surgery (MIS) approach. Multilevel rod and screw fusion provide the strongest biomechanical fixation. This systematic review compares indications, complications, and functional outcomes of different approaches.Methods: A search of multiple databases with keywords "hangman fracture," "hangman's fracture," "axis fracture," and "C2 fracture" was conducted; articles were included if they described the surgical technique and included at least one of the primary outcomes: functional outcomes, complication rates, operation time, and blood loss.Results: A total of 1889 abstracts were screened, 137 full text articles were analyzed, and 36 articles were included, yielding a combined total of 627 patients. ACDF was preferred in unstable fracture patterns. Pre-and postoperative visual analog scale (VAS) scores fell in all groups, with MIS DPS producing the lowest VAS scores. Approaches had excellent neurological improvement and fusion rates. Reported complication rates were generally low; self-limiting dysphagia was most common in the anterior approach and higher volumes of blood loss occured with the posterior approach (255.9 mL in open posterior approach, 75.8 mL in MIS, and 64.3 mL in ACDF).Conclusion: All surgical methods of hangman's fracture fixation have their indications and advantages; surgeons should be equipped to perform all options. Anterior approaches may be preferred for their lower blood loss and access to the disc; however, MIS may improve outcomes in posterior approach.Clinical Relevance: This systematic review can assist spinal surgeons in the selection of the most appropriate surgical option for hangman's fracture and allow surgeons to inform patients of the risks and benefits.

show abstract

Section: Discussionmentioning

confidence: 99%

Surgical Management of Hangman’s Fracture: A Systematic Review

2023

View full text Add to dashboard Cite

show abstract

“…The retropharyngeal approach, also termed the high cervical or submandibular approach, is one of the safest and most effective methods to access the upper cervical spine as it provides wide exposure and feasibility for instrumentation, allowing for extension to the lower cervical spine ( 11 ). Yang et al.…”

Section: Discussionmentioning

confidence: 99%

“…Gokaslan and colleagues described the procedure of a single posterior TER of C2 vertebral tumors, with the two cases both receiving satisfactory outcomes ( 6 , 7 ). Some additional authors have also described techniques of the single anterior approach (transoral, transmandibular, or retropharyngeal) for C2 vertebral tumors, whereas most of the cases barely achieved intralesional or gross total resection (GTR) ( 8 – 11 ).…”

Section: Introductionmentioning

confidence: 99%

Reconstruction after resection of C2 vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh

Du²,

Wei

et al. 2022

Front. Oncol.

View full text Add to dashboard Cite

BackgroundSurgical resection of C2 vertebral tumors is challenging owing to the complex anatomy of C2 vertebrae and the challenges to surgical exposure. Various surgical approaches are available, but some are associated with excessively high risks of complications. An additional challenge is reconstruction of the upper cervical spine following surgery. In the last decade, additive-manufacturing personalized artificial vertebral bodies (AVBs) have been introduced for the repair of large, irregular bony defects; however, their use and efficacy in upper cervical surgery have not been well addressed. Therefore, in this study, we compared instrumented fixation status between patients who underwent conventional titanium mesh reconstruction and those who underwent the same resection but with personalized AVBs.MethodsWe performed a retrospective comparative study and recruited a single-institution cohort of patients with C2 vertebral tumors. Clinical data and imaging findings were reviewed. Through data processing and comparative analysis, we described and discussed the feasibility and safety of surgical resection and the outcomes of hardware implants. The primary outcome of this study was instrumented fixation status.ResultsThe 31 recruited patients were divided into two groups. There were 13 patients in group A who underwent conventional titanium mesh reconstruction and 18 group B patients who underwent personalized AVBs. All patients underwent staged posterior and anterior surgical procedures. In the cohort, 9.7% achieved total en bloc resection of the tumor, while gross total resection was achieved in the remaining 90.3%. The perioperative complication and mortality rates were 45.2% and 6.5%, respectively. The occurrence of perioperative complications was related to the choice of anterior approach (p < 0.05). Group A had a higher complication rate than group B (p < 0.05). Four patients (4/13, 30.8%) developed hardware problems during the follow-up period; however, this rate was marginally higher than that of group B (1/18, 5.6%).ConclusionsTotal resection of C2 vertebral tumors was associated with a high risk of perioperative complications. The staged posterior and retropharyngeal approaches are better surgical strategies for C2 tumors. Personalized AVBs can provide a reliable reconstruction outcome, yet minor pitfalls remain that call for further modification.

show abstract

“…The retropharyngeal approach could be regarded as an alternative treatment for some specific patients with IAAD in recent years 26 . Given the advancements in surgical equipment, a clear surgical field is able to be obtained, with the assistance of a cold light source headset lamp, through the retropharyngeal approach 27 .…”

Section: Advantages Of Retropharyngeal Reduction Platementioning

confidence: 99%

Retropharyngeal Reduction Plate for Atlantoaxial Dislocation: A Cadaveric Test and Morphometric Trajectory Analysis

Meng

et al. 2022

Orthopaedic Surgery

View full text Add to dashboard Cite

Objective: To evaluate the placement feasibility and safety of the newly designed retropharyngeal reduction plate by cadaveric test and to perform morphometric trajectory analysis. Methods:The five cadaveric specimens with intact atlantoaxial joint were enrolled in this study. They were used for simulating the placement process and evaluating the placement feasibility of the retropharyngeal reduction plate. The atlantoaxial dislocation (AAD) of five cadaveric specimens were obtained by proper external force after dissecting ligaments. The retropharyngeal reduction plate was placed on atlantoaxial joint of cadaveric specimens. The X-ray and three-dimensional (3D) spiral CT were used for evaluating the placement safety of retropharyngeal reduction plate. The DICOM data was obtained after 3D spiral CT scanning for the morphometric trajectory analysis. Results:The reduction plates were successfully placed on the atlantoaxial joint of five cadaveric specimens through the retropharyngeal approach, respectively. The X-ray and 3D spiral CT showed the accurate screw implantation and satisfying plate placement. The length of the left/right atlas screw trajectory (L/RAT) was, respectively, 1.73 AE 0.01 cm (LAT) and 1.71 AE 0.02 cm (RAT). The length of odontoid screw trajectory (OST) was 1.38 AE 0.02 cm. The length of the left/right axis screw trajectory (L/RAXT) was, respectively, 1.67 AE 0.02 cm (LAXT) and 1.67 AE 0.01 cm (RAXT). There was no statistical significance between left side and right side in terms of AT and AXT (P > 0.05). The angles of atlas screw trajectory angle (ASTA), axis screw trajectory angle (AXSTA), and odontoid screw trajectory angle (OSTA) were 38.04

show abstract

The High Cervical Anterolateral Retropharyngeal Approach

Cited by 10 publications

References 19 publications

Surgical Management of Hangman’s Fracture: A Systematic Review

Surgical Management of Hangman’s Fracture: A Systematic Review

Reconstruction after resection of C2 vertebral tumors: A comparative study of 3D-printed vertebral body versus titanium mesh

Retropharyngeal Reduction Plate for Atlantoaxial Dislocation: A Cadaveric Test and Morphometric Trajectory Analysis

Contact Info

Product

Resources

About