Anterior Cervical Instrumentation

The anterior approach is frequently used to address degenerative, traumatic, infectious, and oncologic conditions of the subaxial cervical spine. The anterior cervical approach is among the most tolerated operations performed by spine surgeons, with favorable recovery, fusion rates, and postoperative pain outcomes, and the ability to perform direct decompression of the affected spinal cord or nerve root. Treatment plans, however, must be individualized based on each patient’s underlying pathology and associated medical condition. A thorough understanding of the anatomic structures is required for the anterior cervical approach to minimize neurovascular complications, including the sternocleidomastoid, tracheoesophageal bundle, carotid sheath, strap muscles, longus colli, and vertebral artery. The operative approach proceeds along the avascular plane surrounded by the carotid sheath and tracheoesophageal bundle. Several options for anterior column reconstruction exist, depending on the extent of decompression (i.e., discectomy/corpectomy), and these techniques are outlined in this chapter. This chapter details the indications, techniques, and potential complications intrinsic to anterior screw-plate fixation of the cervical spine.