![]() Once surgery is planned for the patient and a posterior approach is chosen, the physical examination should be focused on ensuring that the appropriate landmarks and tactile cues, such as the external occipital protuberance and large C2 and C7 spinous processes, can be palpated. The surgical approach depends on the condition being treated, the specific signs and symptoms, and the patient’s expectations. Although the posterior approach is one of the most elementary approaches in spine surgery, involving a simple midline incision, it is indicated for a variety of cervical spine procedures, including posterior fusion, enlargement of the spinal canal through laminectomy or laminoplasty, excision or debulking of tumors, open treatment of facet dislocations, open reduction of posterior element fractures, decompression of nerve roots, and removal of accessible herniated disks.Ī careful history and physical examination, as well as appropriate imaging studies, should be performed preoperatively in all patients. The midline posterior approach, which is the most commonly used surgical approach to the cervical spine, allows efficient and safe access to the posterior elements of the occipitocervical junction and the subaxial cervical spine. Throughout the procedure, the surgeon should continuously identify and verify the appropriate operated levels clinically and radiographically. Potential complications include spinal cord or nerve injury, especially the greater occipital nerve, and vertebral artery or venous plexus injury.ĭepending on the procedure and the region to be addressed, positioning of the head and neck in flexion and extension must be optimized to gain convenient access and trajectories.ĭuring the operative setup, the surgeon should check the ability to obtain appropriate images with the fluoroscope and verify appropriate head and neck position. The surgical technique involves prone positioning, midline incision, and careful superficial and deep dissection to avoid excessive bleeding. This versatile access is through the midline subperiosteal dissection. It is indicated for a variety of cervical spine procedures, including fusions, decompressions, evacuation of tumors, reduction of facet dislocations and posterior element fractures, and removal of accessible herniated disks. It allows efficient and safe access to the posterior elements of the occipitocervical region and the subaxial cervical spine. The midline posterior approach is the most commonly used approach to the cervical spine. ![]()
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