Vera Vigo1,2, Félix Pastor-Escartín1,3,4, Ayoze Doniz-Gonzalez1, Vicent Quilis-Quesada3,4,5, Pau Capilla-Guasch3,4, José Manuel González-Darder3,4, Pasquale De Bonis2, Juan Carlos Fernandez-Miranda1,6. 1. The Stanford Neurosurgical Training and Innovation Center, Stanford University, Palo Alto, California. 2. Neurosurgery Unit, Ferrara University Hospital, Department of Morphology Surgery and Experimental Medicine, Ferrara, Italy. 3. Department of Neurosurgery, Hospital Clínico Universitario de Valencia, Valencia, Spain. 4. Microneurosurgery Laboratory, Department of Anatomy and Human Embriology, University of Valencia, Valencia, Spain. 5. College of Medicine and Science, Mayo Clinic, Jacksonville, Florida. 6. Department of Neurological Surgery, Stanford University, Palo Alto, California.
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.
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.
Authors: Madeleine de Lotbiniere-Bassett; Arthur Volpato Batista; Carolyn Lai; Trishia El Chemaly; Joseph Dort; Nikolas Blevins; Justin Lui Journal: Int J Comput Assist Radiol Surg Date: 2022-08-07 Impact factor: 3.421