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Journal of Craniovertebral Junction and Spine
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Year : 2018  |  Volume : 9  |  Issue : 3  |  Page : 182-187

Modified high cervical approach for C3-4 anterior pathology in difficult neck patients

1 Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, Chennai, Tamil Nadu, India
2 Department of Neurosurgery, Achanta Lakshmipathi Neurosurgical Centre, Post Graduate Institute of Neurological Surgery, Chennai, Tamil Nadu, India

Correspondence Address:
Dr. Shyam Sundar Krishnan
Achanta Lakshmipathi Neurosurgical Centre, Voluntary Health Services Multi-Specialty Hospital and Research Centre, Rajiv Gandhi Salai, TTTI Post, Taramani, Chennai - 600 113, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcvjs.JCVJS_75_18

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Introduction: The anterior approach to cervical pathologies is a time-tested versatile approach. It is, however, associated with a number of pharyngo-tracheo-laryngeal complications (PTL complications) such as dysphonia, dysphagia, and aspiration, more commonly in high cervical C3-4 inclusive pathologies and even more so in patients with “difficult neck.” The modified high cervical approach was devised and employed to address these issues at our institution. Materials and Methods: Patients who underwent surgery for anterior cervical C3-4 inclusive pathologies between January 2015 and April 2018 were included in the study. Parameters for considering difficult neck were defined. Patient subgroup with difficult neck underwent surgery through a modified high cervical approach, whereas others underwent surgery through a standard approach. The incidence of pharyngo-tracheo-laryngeal complications in both subgroups of this patient set was compared among itself as well with a similar patient set with the same two subgroups, both of which underwent surgery through standard approach alone from May 2010 to December 2014 – before the introduction of modified high cervical approach. Results: A total of 280 patients underwent surgery for C3-4 level pathology between May 2010 and April 2018. There were 197 males and 93 females in this population. Mean age was 45.8 ± 6.3 years. Incidence of pharyngo-tracheo-laryngeal complications was 20.3% in patients who underwent surgery before the employment of modified high cervical approach – 32.4% of difficult neck and 16.6% of others developed features of pharyngo-tracheo-laryngeal complications. After employment of modified high cervical approach, 16.67% of difficult neck and 16.2% of other patients developed features of pharyngo-tracheo-laryngeal complications. Conclusion: The modified high cervical technique is a good surgical option to prevent pharyngo-tracheo-laryngeal complications in cases of anterior C3-4 pathology when operating of patients with difficult neck.

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