Anterior or posterior approach to the cervical spine: an anatomical and radiographic evaluation and comparison.

Both the anterior and the posterior approaches are used in the treatment of cervical radiculopathy. An evaluation of the advantages and limitations of each method as compared to the other was made in isolated cervical spine segments. With a posterior approach, a quarter to a half of the facet joint must be removed to unroot the neural foramen. Anterior osteophytes in the region of the uncovertebral joint are difficult to reach from posteriorly unless they are very large. Using an anterior approach the amount of root decompression is easily overestimated. The lateral limits of the decompression must be beyond direct visualization to equal that obtained posteriorly. Osteophytes in the region of the uncovertebral joints are easily reached. Because some roots leave the dural tube a significant distance above the interspace, a soft disc fragment may migrate out of the interspace and behind the body to compress the root. This fragment may be missed from the anterior approach unless the root anatomy is evaluated carefully. X-ray films were taken at each step of the surgical procedures and were compared. A final set was taken using radiopaque markers to identify key structures. Plain x-ray films of the cervical spine reflect few if any of the anatomical alterations accomplished by operation. Oblique x-ray films do not visualize the entrance of the anatomical foramen, and osteophytes seen on this view may be well anterior in the neural canal.