The anatomical basis of the lateral approach to the upper cervical spine

The lateral retrovascular approach is one of the available options to expose the vertebral bodies or the anterior dural surface of the upper cervical spine. Other options, including standard pre-vascular or anterior parapharyngeal approaches suffer some limitations due to the markedly oblique perspective and the risk of injury to the IX, X and XII cranial nerves. In this cadaver study, the surgical anatomy of the lateral approach to C1-C3 was analyzed. The anatomy of the approach rests on some key points: opening the surgical corridor between the internal jugular vein and the sternocleido-mastoid muscle, identification of the accessory nerve, reflection of the prevertebral muscles, sparing of the cervical sympathetic chain, safe manipulation - if required - of the vertebral artery. The bone removal is variable, depending on the scope of the procedure. The informations gained from this study may contribute to minimize the risk of injury to neurovascular structures associated with the lateral approach.