title: A Tunneled Subcricoid Approach for Anterior Cervical Spine Reoperation: Technical and Safety Results.
abstract: OBJECTIVE
  Anterior cervical spine decompression and fusion are common neurosurgical operations. Reoperation of the anterior cervical spine is associated with increased morbidity. The authors describe a novel subcricoid approach to protect the recurrent laryngeal nerve in a cuff of tissue while facilitating surgical access to the anterior cervical spine.
  
  
  METHODS
  Single institution, consecutive case review of 48 patients undergoing reoperation in the anterior cervical region including the level of C5 and below. Univariable and multivariable regression analysis was used to determine predictors of postoperative morbidity.
  
  
  RESULTS
  No intraoperative complications were reported. Estimated blood loss for the approach was 13.6 ± 3.1 mL. Nine of 48 patients developed immediate postoperative complications, including vocal cord paresis (10.4%), moderate-to-severe dysphagia (10.4%), and neck edema requiring intubation (2.1%). No postoperative hematomas or death occurred. All complications occurred with 4 or more levels of exposure (1-3 disc levels, 0%, vs. ≥ 4 disc levels, 31%). Extension of the exposure to the upper thoracic spine was associated with odds for postoperative complications (adjusted odds ratio, 6.50; 95% confidence interval, 1.14-37.03) and prolonged hospital stay (adjusted increase 4.23 days, P < 0.01).
  
  
  CONCLUSIONS
  The tunneled subcricoid approach is a relatively safe corridor to reapproach the anterior cervical spine at the level of C5 and below. However, caution must be exercised when using this approach to expose 4 or more disc levels and with extension of the exposure to the upper thoracic spine. Future comparative studies are needed to establish patient selection criteria in determining the use of this technique compared with classic approaches.
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Ethan A
authors.initials: EA
authors.lastname: Winkler
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Rowland
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: John K
authors.initials: JK
authors.lastname: Yue
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Harjus
authors.initials: H
authors.lastname: Birk
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Alp
authors.initials: A
authors.lastname: Ozpinar
authors.affiliation: Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Bobby
authors.initials: B
authors.lastname: Tay
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: Department of Neurological Surgery, University of California San Francisco, San Francisco, California, USA.
authors.forename: Praveen V
authors.initials: PV
authors.lastname: Mummaneni
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA. Electronic address: ielsayed@ohns.ucsf.edu.
authors.forename: Ivan H
authors.initials: IH
authors.lastname: El-Sayed
mesh_terms: D000293:Adolescent; D000328:Adult; D002574:Cervical Vertebrae / Q000033:anatomy & histology* / Q000601:surgery*; D003413:Cricoid Cartilage / Q000033:anatomy & histology* / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects / Q000379:methods*; D003680:Deglutition Disorders / Q000453:epidemiology / Q000209:etiology; D004487:Edema / Q000209:etiology; D005260:Female; D006801:Humans; D007828:Laryngoscopy; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000033:anatomy & histology / Q000601:surgery; D019635:Neurosurgical Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012086:Reoperation; D012189:Retrospective Studies; D013117:Spinal Cord Compression / Q000601:surgery*; D013131:Spine / Q000033:anatomy & histology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000033:anatomy & histology / Q000601:surgery; D014826:Vocal Cord Paralysis / Q000453:epidemiology / Q000209:etiology; D055815:Young Adult
keywords: Anterior cervical discectomy and fusion; Approach; Complication; Recurrent laryngeal nerve; Reoperation