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152 Section III: Spinal Procedures

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Figure 16.4 Typical patient positioning for dorsal approach to the cervical spine for laminectomy/hemilaminectomy. Effort should be made to align the
head, neck, and trunk so that there is no rotation or turning of the spinal column, and that the spine is neutral or slightly flexed, and not extended. A vacuum
positioner (as shown here) or sandbags and towels are used with adhesive tape to secure the head and neck so that no movement occurs intraoperatively.
Compression of the jugular veins should be avoided since this could lead to dilation of the vertebral venous sinuses. The thoracic limbs are usually secured
cranially as depicted here, but for approaches to the caudal cervical and cranial thoracic vertebrae it may be advantageous to cross the thoracic limbs ventral
to the neck to the contralateral side in order to abduct the scapulae.

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Figure 16.5 Dorsal approach to cervical spine. (A) After the skin, subcutaneous tissue, and initial fascial layers are incised on the midline, superficial nerve
branches become evident (arrows). These may be sacrificed without functional consequence. (B) Separation of superficial musculature on the dorsal mid-
line exposes the paired nuchal ligaments (arrow). These can be treated as a single ligament and retracted together to one side. (C) Self‐retaining retractors
have been placed to deviate the nuchal ligaments to the patient’s right side (head is to the left), and the multifidus muscles have been partially elevated,
exposing the spinous processes of the cervical vertebrae (arrows). Source: Courtesy of Dr. William B. Thomas.