July 18, 2024

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
Smith-Robinson approach incision
  • Platysma transversely transected, exposing sternohyoid medially and SCM laterally
Smith-Robinson approach Dissection
  • Omo-hyoid retracted divided
  • Pre-tracheal Fascia–>Longitudinal dissection

[ Carotid Sheath = laterally]

[ Trachea+ esophagus —> medially]

Smith-Robinson approach

Inferior Thyroid Artery ligated (lower cervical spine)

Smith-Robinson approach Exposure
  • 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

The posterior approach of the lumbar spine

Pedicle screw
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