Complications Related to Posterior Approach

The posterior approach through a midline longitudinal incision provides the most direct access to the posterior elements of the cervical spine. Through this approach, the posterior elements of the cervical spine can be removed, and access to the posterior aspect of the spinal cord and nerve roots from the occiput to C7 can be obtained. The posterior approach to the cervical spine allows excellent exposure to perform several surgical techniques, with or without internal fi xation. It can also be a useful rostral extension of a longer posterior thoracic spinal approach [1] . The posterior elements of the cervical spine play an important role in the stabilization of the cervical spine. Indeed, their removal in patients undergoing wide laminectomies (i.e., for the management of pathologies such as the spondylotic myelopathy, or extraor intra-medullary tumors) may cause subluxation, or severe kyphotic angulation of the spine (i.e., swan neck), causing increased compression of the neural elements and worsening of neurological defi cits [1] . In some patients, if necessary, with careful retraction and protection of the neural structures, it is possible to expose the anterior side of the spinal canal (actually the lateral side of the posterior wall of the vertebral body and the intervertebral disk space), the pedicles, and the posterior portion of the root canals. With this approach, however, the surgeon should not expect to be able to reach the central region of the posterior vertebral bodies [1] . This would involve particularly diffi cult (if not impossible) retraction or displacement of neural structures, which might produce severe neurological damage [2] . Complications Related to Posterior Approach