Introduction: Anterior cervical approaches were first routinely performed by Cloward and Robinson. The following incisions have been most commonly used: For one- or two-level procedures, a curvilinear paramedian skin incision; for three or four-level anterior cervical procedures large vertical incision along the anterior border of the sternocleidomastoid muscle. We describe a curvelinear incision centered over the midline for the anterior cervical approach and describe its advantages compared with the previously described incisions based on the authors` experience.
Methods: After soft tissue dissection the median skin incision allows the anterior cervical retraction system to be placed symmetrically over the anterior cervical spine. Thereby the straight view allows better symmetrical neural decompression compared to the more oblique view after a paramedian skin incision.
Results: Short- and long-term complications such as dysphagia, implant failure and recurrent nerve palsy occurred in less than 5 % and do not exceed other series. Esophageal injury occured in one patient with previous radiadtion therapy.
Conclusions: The curvelinear midline incision is simple, safe, cosmetically acceptable and provide a shorter working distance.
Patient Care: The curvelinear midline skin incision is cosmetically acceptable especially in case of three- and four level procedures. By providing a straight view on the anterior cervical spine symmetric decompression of the spinal cord is more feasible.
Learning Objectives: By the conclusion of this session, participants should be able to call longstanding surgical dogmas into question and think about new simple strategies making surgery more simple and effective.