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Vigo V, Pastor-Escartín F, Doniz-Gonzalez A, Quilis-Quesada V, Capilla-Guasch P, González-Darder JM, De Bonis P, Fernandez-Miranda JC. The Smith-Robinson Approach to the Subaxial Cervical Spine: A Stepwise Microsurgical Technique Using Volumetric Models From Anatomic Dissections. Oper Neurosurg (Hagerstown) 2020; 20:83-90. [PMID: 32864701 DOI: 10.1093/ons/opaa265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Accepted: 06/18/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The Smith-Robinson1 approach (SRA) is the most widely used route to access the anterior cervical spine. Although several authors have described this approach, there is a lack of the stepwise anatomic description of this operative technique. With the advent of new technologies in neuroanatomy education, such as volumetric models (VMs), the understanding of the spatial relation of the different neurovascular structures can be simplified. OBJECTIVE To describe the anatomy of the SRA through the creation of VMs of anatomic dissections. METHODS A total of 4 postmortem heads and a cervical replica were used to perform and record the SRA approach to the C4-C5 level. The most relevant steps and anatomy of the SRA were recorded using photogrammetry to construct VM. RESULTS The SRA was divided into 6 major steps: positioning, incision of the skin, platysma, and muscle dissection with and without submandibular gland eversion and after microdiscectomy with cage positioning. Anatomic model of the cervical spine and anterior neck multilayer dissection was also integrated to improve the spatial relation of the different structures. CONCLUSION In this study, we review the different steps of the classic SRA and its variations to different cervical levels. The VMs presented allow clear visualization of the 360-degree anatomy of this approach. This new way of representing surgical anatomy can be valuable resources for education and surgical planning.
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Affiliation(s)
- Vera Vigo
- The Stanford Neurosurgical Training and Innovation Center, Stanford University, Palo Alto, California.,Neurosurgery Unit, Ferrara University Hospital, Department of Morphology Surgery and Experimental Medicine, Ferrara, Italy
| | - Félix Pastor-Escartín
- The Stanford Neurosurgical Training and Innovation Center, Stanford University, Palo Alto, California.,Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Microneurosurgery Laboratory, Department of Anatomy and Human Embriology, University of Valencia, Valencia, Spain
| | - Ayoze Doniz-Gonzalez
- The Stanford Neurosurgical Training and Innovation Center, Stanford University, Palo Alto, California
| | - Vicent Quilis-Quesada
- Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Microneurosurgery Laboratory, Department of Anatomy and Human Embriology, University of Valencia, Valencia, Spain.,College of Medicine and Science, Mayo Clinic, Jacksonville, Florida
| | - Pau Capilla-Guasch
- Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Microneurosurgery Laboratory, Department of Anatomy and Human Embriology, University of Valencia, Valencia, Spain
| | - José Manuel González-Darder
- Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain.,Microneurosurgery Laboratory, Department of Anatomy and Human Embriology, University of Valencia, Valencia, Spain
| | - Pasquale De Bonis
- Neurosurgery Unit, Ferrara University Hospital, Department of Morphology Surgery and Experimental Medicine, Ferrara, Italy
| | - Juan Carlos Fernandez-Miranda
- The Stanford Neurosurgical Training and Innovation Center, Stanford University, Palo Alto, California.,Department of Neurological Surgery, Stanford University, Palo Alto, California
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Fard SA, Patel AS, Avila MJ, Sattarov KV, Walter CM, Skoch J, Baaj AA. Anatomic considerations of the anterior upper cervical spine during decompression and instrumentation: a cadaveric based study. J Clin Neurosci 2015; 22:1810-5. [DOI: 10.1016/j.jocn.2015.05.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Accepted: 05/06/2015] [Indexed: 11/25/2022]
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