ANTERIOR AND ANTERO-LATERAL SURGERY OF TH E LOWER CERVICAL-SPINE - (25 YEARS AFTER VERBIEST,H.) .1. TECHNICAL BASES

The anterior approach to the cervical spine is currently a worldwide t raditional surgical technique used by neurosurgeons or orthopedists in the treatment of traumatic, degenerative or tumoral cervical spinal l esions. Many original rules of these techniques were raised by pioneer s as R. Cloward and H. Verbiest, and are still valid. Advances in the surgical armentarium and in bio-materials markedly improved the origin al technique and subsequently improved the clinical results. The prese nt course was organized for the neurosurgery trainees by the French Sp eaking Neurosurgical Society, and was helded during the winter meeting in December 1995. The aim of this course is to recall the basic techn ical principles of the microsurgical anterior cervical approach, and t o discuss the main indications of this surgical treatment. Many theore tical points are strengthened by the author's personal experience and comments. Part I presents the different anterior or antero-lateral app roaches which any surgeon involved in cervical spine surgery actually needs to know. Secondly, the materials and technical basis needed to a chieve an interbody graft or fusion or fixation are described. Lastly, some practical applications are detailed as a microdiscectomy, a medi al or lateral cervical spine decompression, and the use of acrylic pla stic or prothesis for a cervical vertebral replacement.