Bilateral anterolateral approach in primary tumors of the cervical vertebrae

The author reports on his experience with the bilateral anterolateral approach to the cervical spine for primary tumors of the cervical spine. It has a threefold objective: Neurological: aiming at the decompression of the spinal cord and the roots as much as possible without making any radicular or vascular sacrifice. Anatomic: the bilateral control of the foraminal segment and the vertebral arteries ensures absolute safety for the approach to the lateral parts of the vertebral body, the pedicles, and if necessary, the articular surfaces and the isthmi. Static: the anterior reconstruction graft and osteosynthesis with a plate or an acrylic prothesis ensure stability. Compared with the classic anterior approach, the bilateral anterolateral approach offers the following advantage: it allows more extensive surgery on tumors. However, the posterior segment of the spine appears to be difficult to control by this approach. An anterior support is necessary because of the removal of the stabilizing elements of the vertebra. Computed tomography provides great help in determining the exact indications for this surgical procedure.