Laus M, Alfonso C, Laguardia A M, Giunti A
Clinica Ortopedica dell'Università, Istituto Ortopedico Rizzoli, Bologna.
Chir Organi Mov. 1993 Apr-Jun;78(2):65-75.
Anterior surgery of the upper part of the cervical spine, that is, proximal to C3, may be performed by transoral approach, possibly enlarged by glossomandibulotomy, by a retrovascular extraoral approach, or by a prevascular extraoral approach. The authors describe the surgical method of prevascular extraoral approach that allowed them to effectively treat osteoma localized at C2 and C3, post-laminectomy instability at C3 and C4, solitary metastasis at C3. As compared to transoral surgery the prevascular extraoral approach has the advantage of avoiding the risk of infection from germs in the oral cavity and of allowing for easier postoperative management, avoiding tracheotomy and/or prolonged dysphagia. As compared to a retrovascular approach the prevascular approach obtains a truly anterior exposure instead of an anterolateral one. Prevascular extraoral approach should thus be used whenever possible. Transoral surgery is indicated for decompression, of the brainstem and a bilateral retrovascular approach may be used to perform anterolateral fusion at C1-C2.
颈椎上部（即C3以上）的前路手术可通过经口入路进行，必要时可通过舌下颌切开术扩大切口，也可采用经口后血管入路或经口前血管入路。作者描述了经口前血管入路的手术方法，该方法使他们能够有效治疗位于C2和C3的骨瘤、C3和C4椎板切除术后的不稳定以及C3的孤立转移瘤。与经口手术相比，经口前血管入路具有避免口腔细菌感染风险以及便于术后管理的优点，可避免气管切开术和/或长期吞咽困难。与经口后血管入路相比，经口前血管入路可获得真正的前路暴露，而非前外侧暴露。因此，应尽可能使用经口前血管入路。经口手术适用于脑干减压，双侧经口后血管入路可用于C1-C2的前外侧融合。
