Department of Neurosurgery, Sant'Anna University Hospital, Viale Aldo Moro 8, 44124, Ferrara, Italy.
Department of Neurosurgery, Santa Maria Goretti Hospital, Latina, Italy.
Eur Spine J. 2020 Nov;29(11):2752-2757. doi: 10.1007/s00586-020-06521-5. Epub 2020 Jul 9.
In this paper, we propose a simplified four-step retropharyngeal approach, whose aim is getting straight to the upper cervical spine minimizing complications.
While the classical retropharyngeal approach includes about 11 steps, ours is a four-step approach: patient positioning, skin-platysma incision, hyoid bone superolateral dissection and retropharyngeal blunt exposure. We avoid several steps of the classical anterior retropharyngeal approach, particularly dissection of submandibular gland, facial veins, external carotid artery and thyroid artery, bellies of the digastric muscle, hypoglossal nerve, thyrohyoid membrane and the internal branch of superior laryngeal nerve.
We have adopted this technique for five patients: two patients had a C2-C3 herniated disk with myelopathy, two patients had unstable Hangman fracture with no bone fusion after 2-month treatment with rigid collar, and one patient had a C2-C3 osteophyte with dysphagia. The intraoperative time needed for reaching the retropharyngeal space was 15 (first case), 9 (second case), 7 min (third case-illustrative case-and fourth case), 8 min (fifth case). No complications occurred.
Our simplification, avoiding several steps, is simple, effective, safe, and rapid and requires a simple learning curve.
本文提出了一种简化的四步咽后入路，旨在通过最小化并发症来直接进入上颈椎。
经典咽后入路包括约 11 个步骤，而我们的方法是四步入路：患者体位、皮肤-颈阔肌切口、舌骨超外侧解剖和咽后钝性暴露。我们避免了经典咽后入路的几个步骤，特别是下颌下腺、面静脉、颈外动脉和甲状腺动脉、二腹肌肌腹、舌下神经、甲状舌骨膜和喉上神经内支的解剖。
我们已经将该技术应用于五名患者：两名患者因 C2-C3 椎间盘突出合并脊髓病，两名患者因 Hangman 骨折不稳定，在使用刚性颈托治疗 2 个月后无骨融合，一名患者因 C2-C3 骨赘合并吞咽困难。到达咽后间隙所需的手术时间分别为 15 分钟（第一例）、9 分钟（第二例）、7 分钟（第三例-示范病例和第四例）、8 分钟（第五例）。无并发症发生。
我们的简化方法避免了几个步骤，简单、有效、安全、快速，且学习曲线简单。
