Transcervical approaches to the prevertebral space

The anterolateral and posterolateral transcervical approaches were used to expose the prevertebral space in patients with diffuse idiopathic skeletal hyperostosis. In a series of six patients, both techniques produced equally effective palliation of dysphagia without associated morbidity. Theoretically, the anterolateral approach better preserves the carotid sheath neurovascular bundle, although the risk of injuring the recurrent laryngeal nerve is greater. The posterolateral technique offers a wider exposure of the prevertebral space but requires more retraction of the carotid sheath and increases the risk of injury to the sympathetic chain. Either exposure may be used depending on the preference of the attending surgeon.