The common approaches for the spine are Smith-Robinson for the cervical spine and posterior for the lumbar spine which is discussed below. The steps of these approaches are:
Smith-Robinson approach (Anterior Cervical orientation)
Steps to follow in this approach are
- Transverse / Oblique incision from the medial border of SCM muscle to the midline
- Platysma transversely transected, exposing sternohyoid medially and SCM laterally
- Omo-hyoid retracted divided
- Pre-tracheal Fascia–>Longitudinal dissection
[ Carotid Sheath = laterally]
[ Trachea+ esophagus —> medially]
Inferior Thyroid Artery ligated (lower cervical spine)
- Prevertebral fascia split longitudional
- Longus coli elevated off vertebrae
The anterior cervical approach in details
Posterior approach To Lumbar Spine
Steps to follow in this approach are:
Landmarks – Palpate spinous process (midline)
Mid-line Incision
Incise fat =>lumbo-dorsal fascia to the spinous process
Detach para-spinal muscle (erector spinae sub periostially)
Dissect down spinous process and lamina to facet joint
More medial to lateral taking down or sparing facet capsule
Cont. anterior to transverse process if necessary
Deep:
Remove ligamentum flavum by cutting attachment to the edge of the lamina
Identify epidural fat/ dura
With blunt dissection stay lateral to dura
Closure: fascia closed with water-tight closure
Erector Spinae muscle:
- Illicostalis muscle
- Longissimus muscle
- Spinalis muscle
