Combined anterior, antero-lateral and lateral approaches to the cervical spine. Advocating the brachial plexus approach to the crossing of spine and nerve.

Abstract

<h4>Introduction</h4>The aim for total resection of large cervical tumors extending from the dura through the neuroforamen in the direction of the brachial plexus presents significant surgical challenges due to the complex anatomy and the risk of neurological injury. Traditional anterior approaches often provide limited visualization of the spinal nerves contributing to the brachial plexus and the phrenic nerve as these are lateral to the tumor mass.<h4>Research question</h4>Can a combined anterior, antero-lateral, and lateral approach with early identification of the nerves of the brachial plexus facilitate tumor resection and contribute to preserving neurological function.<h4>Methods</h4>A series of four illustrative cases is presented to illustrate this combined surgical approach which allows for tailored access to both medial and lateral aspects of the cervical spine.<h4>Results</h4>A combination of approaches enlarged the overview of the course of the nerves and was thereby instrumental in keeping the neurological function intact.<h4>Conclusion</h4>We advocate for broader adoption of this novel technique in complex cervical tumor surgeries where preservation of neurological function is paramount.