The Inter-Sternohyoid Median (ISM) Approach: A Novel Midline Anterior Corridor to the Cervical Spine – Anatomical, Radiological and Preliminary Case Series Results

Purpose: While traditional anterolateral approaches provide effective access to the subaxial cervical spine, their oblique trajectory poses certain limitations. The aim of this study was to describe the Inter-Sternohyoid Median (ISM) approach, a novel midline anterior route to the cervical spine, and to present its anatomy, surgical technique, and preliminary clinical application. Methods: Cadaveric dissections were performed to delineate the surgical corridor and identify key anatomical landmarks. Projectional radiography with radiopaque markers was used to confirm vertebral levels and the extent of exposure. Subsequently, a preliminary clinical series of twenty-five patients was conducted, documenting operative time, clinical outcomes, and complications. Results: The ISM approach provided a short, perpendicular trajectory to the cervical spine, allowing medial exposure with minimal tissue retraction. Radiographs demonstrated consistent multilevel subaxial exposure through a single incision. In the clinical series, corridor creation required 7–10 minutes and was reproducible across surgeons. Target levels were successfully exposed in all patients, with no intraoperative or postoperative complications. No cases of dysphagia, recurrent laryngeal nerve injury, or hematoma were observed. Conclusion: The ISM approach offers a direct, safe, and reproducible midline corridor to the cervical spine, minimizing retraction and facilitating perpendicular instrumentation. Preliminary anatomical and clinical findings suggest potential advantages over standard anterolateral techniques. Larger prospective studies are warranted to confirm its safety, clinical efficacy, and long-term functional outcomes.