Without special modifications, a routine anterior cervical approach is usually able to access levels C3–7. In patients with short thick necks, access may be even more limited. In some cases, with long thin necks, up to C2–3 or as low as C7-T1 can be approached anteriorly.
Approach to the anterior subaxial cervical spine or the high thoracic spine is more challenging and harbors approach-related complication. Pre-operative evaluation of patients imaging allows harnessing the standard approach for treatment of extreme levels with relative safety and efficiency. Spine surgeons' awareness to this technique may increase surgical efficacy while reducing the complication rates 1).