Vol. 7, Issue 2, Part B (2025)

High cervical spine surgery presents significant technical challenges and risks. The classical anterior retropharyngeal approach is complex and associated with notable complications. De Bonis proposed a four-step simplified retropharyngeal approach to mitigate these risks while facilitating a more accessible surgical procedure.
This simplified approach to upper cervical spine surgery eliminates critical steps of the classical method, thereby reducing the risk of complications and proving to be effective, safe, and reducing surgical exposure time while requiring a relatively short learning curve. Further studies are necessary to establish its role as the gold standard for high cervical spine surgery.
We present the case of an 80-year-old woman with unstable atypical C2-C3 traumatic spondylolisthesis without neurological impairment. Due to a suspected anterior longitudinal ligament injury and multiple facial fractures, a posterior approach was deemed unsuitable. The patient underwent C2-C3 anterior discectomy and fusion with a locking plate and autologous bone graft using an anterior submandibular approach following the simplified technique described by De Bonis. The procedure was uneventful, with no postoperative complications. At 12 months postoperatively, a Computerized Tomography (CT) scan confirmed complete fusion, and the patient had returned to normal daily activities with full autonomy.