Approaches to Cervical Spine

Abstract

The evolution of spinal surgery has revolved around three basic surgical principles: decompression, stabilisation and deformity correction. From a historical point of view, laminectomy was the only procedure for trauma, tumor and infection of the spine. Anterior cervical spine approaches were developing in the 1950s with Robinson and Smith, Dereymaker and Moulier, and Cloward [3]. Thereafter, Caspar’s instrumentation clearly influenced the dominant use of anterior cervical approach (discectomy with fusion) long before the cage, dynamic plating and arthroplasty area. Anterolateral approaches initiated 1968 by Verbiest saw further development with George and miniaturisation with Hakuba and Jho [4]. Meantime, and mainly because of instability recognition, there was new development in posterior approaches in 1970s with laminoplasty (Hirabayashi), posterior instrumentation (Roy-Camille), foraminotomy (Kempe) and endoscopic decompression (Theron) in 1990s [2, 9]. The complex area of upper cervical spine and craniovertebral junction was even more dependent on surgical technology, imaging and monitoring improvements to find the best approach [1, 5]: transoral or transcervical with dens resection (Menezes), direct anterior odontoid peg fixation (Apfelbaum) or occipito-cervical stabilisation (Grob). Benzel’s recent book about spine surgery is an excellent reference for history, biomechanics, indications, techniques and management according to approaches [2].