Background. The transverse skin incision for anterior cervical spine surgery is not extensile, thus it must be made at the accurate level. The use of palpable bony landmarks is unreliable due to anatomical variations and pre-operative fluoroscopy to identify the level takes up operating room time, increases the radiation dose to the patient and increases the overall cost of the operation. Objective. To describe a simple, fast and inexpensive method of accurate transverse skin incision placement for anterior cervical spine surgery and to report on its use in 54 consecutive adult patients. Patients and Methods. In each case a ratio was recorded on the lateral cervical spine radiograph based on the distance between the clavicle and mandible and the operative level; this was then applied to measurements on the patient's neck. Results. Procedures performed consisted of a mix of discectomy and fusion, disc replacement and combinations of both. The operative level ranged from C2-C3 to C7-T1, the most common being C5-C6. Twenty-three patients had a single-level, 26 a two level and 5 a three level procedure; all cases were performed through one single transverse incision. Conclusion. We describe the highly successful use of a straightforward method for accurate level transverse skin incision placement for cervical spine surgery In no case was it necessary to radically extend or to make a separate incision. There were no cases where the wrong level was operated on

Background:. Cervical spine injured patients often require prolonged ventilatory support due to intercostal paralysis and recurrent chest infections. This may necessitate tracheotomy. Concern exists around increased complications when anterior cervical spine surgery and tracheotomies are performed. Objective:. The primary aim of this study was to evaluate the effect of tracheostomy in anterior cervical surgery patients in term of complications. In addition, the aetiology of trauma and incidence of anterior surgery and ventilation in this patient group was assessed. Methods:. Patients undergoing anterior cervical surgery and requiring ventilation were identified from the unit's prospectively maintained database. These patients were further sub-divided into whether they had a tracheotomy or not. The aetiology of injury and incidence of complications were noted both from the database and a case note review. Results:. Of the 1829 admissions over an 8.5 year period, 444 underwent anterior cervical surgery. Of these 112 required ventilation, and 72 underwent tracheotomy. Motor vehicle accidents, followed by falls, were the most frequent cause of injury. There was a bimodal incidence of tracheostomy insertion; on the day of spine surgery and 6–8 days later. There was no difference in the general complication rate between the two groups. With regards to specific complications attributable to the surgical approach / tracheotomy, there was again no statistically significant difference. The timing of the tracheotomy equally had no effect on complication rate. Although the complications occurred mostly in the formal insertion group as opposed to percutaneous insertion technique, this was most likely due to selection bias. Conclusion:. Anterior cervical surgery and subsequent tracheostomy are safe despite the intuitive concerns. Timing does not affect the incidence of complications and there is no reason to delay the insertion of the tracheotomy. Ventilation in general is associated with increased complications rather the tracheotomy tube