Posterior approach to the Cervical Spine

Indications

• Entire cervical spine
  • Posterior spinal fusion
  • Herniated discs
  • Tumours
  • Facet joint dislocations
  • Nerve root exploration

Position

• prone
• mayfield head rest
  • flex head a few°
• Prep & Drape

Landmarks

• Spinous processes
  • C2
  • C7
  • T1
• Identify level with Spinal needle & II

Incision

• Straight longitudinal midline incision

Internervous Plane

• Left & right paracervical muscles
  • Supplied segmentally by posterior rami

Superficial Dissection

• Continue incision down to spinous processes
• Reflect paraspinal muscles subperiosteally using a Cobb Elevator
• Carry the dissection laterally to reveal the Lamina, Facet Joints, & Transverse Processes

Deep Dissection

• Identify Ligamentum Flavum & remove it from the Superior edgee of the Inferior Lamina
• Perform a laminotomy / laminectomy
• Expose blue white dura & epidural fat
• Gently retract the spinal cord medially to expose the vertebral body, disc space
• Watching for the thin epidural veins

Dangers

• Nerves
  • Spinal cord
  • Nerve roots
• Vessels
  • Venous plexus in the cervical canal