Minimally Invasive Anterior Approach to Upper Cervical Spine
Bibliographic record
Abstract
OBJECTIVE: The transoral approach of Spetzler is the classic anterior access to the upper cervical spine that provides direct exposure for anterior decompression of the spinal cord. The risks of infection, the limits in extension, and the postoperative recovery difficulties of transmucosal access suggest the use of an alternative anterior extraoral approach in upper cervical surgery. However, this approach results in complications from nerve palsy because of excessive retraction of the hypoglossal and the superior laryngeal nerves. The goal of this work was to provide anatomic data for an anterior retropharyngeal upper cervical approach through a minimally invasive window below the hypoglossal and the superior laryngeal nerves. METHODS: In two adult cadaveric cervical spines, the anterior approach using the Metrx tubular retractor system through a window between the hypoglossal nerve and the superior laryngeal nerve, as well as below these two nerves, is compared in the exposure of C1 and C2 anteriorly with the aid of an operating microscope. RESULTS: A maximum diameter of the internervous window for the tubular retractor is reached beyond which the superior laryngeal nerve will be excessively stretched. Conversely, the tubular retractor can retract the superior laryngeal nerve superiorly without undue tension. Better proximal exposure is also made possible by angling an end-beveled tubular retractor on the mandible without undue compression on the hypoglossal and superior laryngeal nerves, the marginal mandibular branch of the facial nerve, and the submandibular gland. CONCLUSION: This minimally invasive approach can replace transoral surgery, allowing direct anterior access to C1 and C2 while allowing extension to the lower cervical spine.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.000 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.001 |
| Insufficient payload (model declined to judge) | 0.007 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".