Minimally invasive cervical spine foraminotomy and lateral mass screw placement.
METHODS
This technique article describes accomplishing multilevel posterior cervical decompression and lateral mass screw placement through a tubular retraction system.


OBJECTIVE
Multilevel foraminotomy and instrumented fusion using lateral mass screw fixation can be achieved through a minimally invasive technique using specialized retractors and intraoperative fluoroscopic imaging.


BACKGROUND
Minimally invasive surgical techniques have been adapted to the cervical spine with good results. These techniques have the theoretical advantages of reducing morbidity, blood loss, perioperative pain, and length of hospital stay associated with conventional open posterior spinal exposure.


METHODS
Minimally invasive access to the posterior cervical spine was performed with exposure through a paramedian muscle-splitting approach. With the assistance of a specialized tubular retraction system with a deep soft tissue expansion mechanism, multilevel posterior cervical decompression and fusion can be accomplished.


RESULTS
Minimized access to perform multilevel posterior cervical foraminotomy and fusion can be safely accomplished with tubular retraction systems. Complications associated with these techniques can include inadequate decompression, improper instrumentation placement, or neurologic injury due to poor access and visualization.


CONCLUSIONS
Multilevel foraminotomy and instrumented fusion using lateral mass screw fixation can be safely achieved using these techniques. Complications associated with these strategies are typically due to inadequate visualization, incomplete decompression, or poor placement of instrumentation. As with all minimally invasive spine techniques, the surgeon must ensure that goals of the surgery, both technical and clinical outcomes, are comparable to those of a conventional open procedure.
Department of Orthopedic Surgery, UCLA Comprehensive Spine Center, Santa Monica, CA 90404, USA. MMikhael@mednet.ucla.edu
Mark M
MM
Mikhael
Paul C
PC
Celestre
Christopher F
CF
Wolf
Tom E
TE
Mroz
Jeffrey C
JC
Wang
D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery*; D006801:Humans; D007796:Laminectomy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods*; D011183:Postoperative Complications / Q000209:etiology / Q000517:prevention & control; D011843:Radiculopathy / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D013123:Spinal Fusion / Q000295:instrumentation / Q000379:methods*; D055009:Spondylosis / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*