Purpose

In this paper, we propose a simplified four-step retropharyngeal approach, whose aim is getting straight to the upper cervical spine minimizing complications.

Methods

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.

Results

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.

Conclusion

Our simplification, avoiding several steps, is simple, effective, safe, and rapid and requires a simple learning curve.

中文翻译：

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上颈椎简化的四步咽后入路：技术说明。

目的

在本文中，我们提出了一种简化的四步咽后入路方法，其目的是直达上颈椎，以最大程度地减少并发症。

方法

虽然经典的咽后入路包括大约11个步骤，但我们的方法是四步式：患者定位，皮肤胸膜切开术，舌骨舌骨上外侧解剖和咽后钝暴露。我们避免了经典的咽后前入路的几个步骤，特别是解剖下颌下腺，面静脉，颈外动脉和甲状腺动脉，腹肌的腹，舌下神经，甲状腺舌骨膜和喉上神经的内部分支。

结果

我们对五名患者采用了该技术：两名患者患有C2–C3椎间盘突出症并伴有脊髓病；两名患者在进行了2个月的刚性衣领治疗后出现不稳定的Hangman骨折，没有骨融合；另一名患者患有C2–C3骨赘。吞咽困难。到达咽后间隙所需的术中时间为15（第一例），9（第二例），7分钟（第三例-说明性病例-和第四例），8分钟（第五例）。没有并发症发生。

结论

我们的简化过程避免了几个步骤，简单，有效，安全且快速，并且需要简单的学习曲线。