Fusion and instrumentation at C1-3 via the high anterior cervical approach

Object. The high anterior cervical, retropharyngeal approach to the anterior foramen magnum and upper cervical spine is a favorable alternative to the transoral and posterolateral approaches, which both cause instability of the craniovertebral junction. Previously, such instability was corrected via an occipitocervical fusion during a separate surgical procedure. Methods. Seven patients requiring C-2 corpectomy (foramen magnum meningioma [two patients], critical stenosis secondary to rheumatoid arthritis [two patients], C-2 fracture [two patients], and stenosis secondly to Rickets [one patient]) are presented. All patients underwent C1-3 fusion followed by instrumentation with a Caspar plate. A solid fusion was achieved in six patients. One patient experienced erosion of the anterior arch of C-1 requiring posterior stabilization. Conclusions. Fusion and instrumentation at C1-3 can be performed safely and with minimal increase in surgical time. In selected patients, this may eliminate the need for an additional posterior procedure and maintain occipital-C1 mobility.