A, Anterolateral approach to the cervical spine through the interval between the sternocleidomastoid laterally and along the internal jugular vein medially with the other vascular structures including the internal carotid and external carotid. The XI cranial nerve is identified at C2 to 4 (CN XI). The longus coli aponeurosis is longitudinally opened and the sympathetic chain is identified and carefully protected while exposing the uncovertebral joints and the anterior surface of the transverse process. The foramen is opened over the vertebral artery. B, Bony exposure through wedge-shaped lateral decompression. C, CT after wedge decompression. D, Postoperative MRI showing decompression. (From Chibbaro S, Mirone G, Bresson D, George B: Cervical spine lateral approach for myeloradiculopathy: technique and pitfalls, Surg Neurol 72:318, 2009.) SEE TECHNIQUE 37.6.