title: Application of a Far-Lateral Approach to the Subaxial Spine: Application, Technical Difficulties, and Results.
abstract: OBJECTIVE
  The far-lateral approach has traditionally been used as an approach to ventral foramen magnum pathologies. Ventral pathologies in the cervical spine and cervicodorsal regions also provide unique surgical challenges. Traditional posterior surgical approaches to the ventral cervical pathologies require significant cord retraction, and anterior approaches require significant bone removal with implant stabilization. We approached these lesions using a modification of the far-lateral approach for lesions in the subaxial spine.
  
  
  METHODS
  Four patients underwent operations using this approach for ventral intradural pathologies in the subaxial spine. Two of the patients had recurrence of the lesions and underwent previous operations using a traditional midline approach.
  
  
  RESULTS
  All 4 patients underwent operations using this approach. This provided a unique view of the ventral pathologies and a scarless field in recurrent cases. All 4 patients improved neurologically after the surgery and had no deterioration or complications related to the surgery.
  
  
  CONCLUSIONS
  We propose extension of far-lateral approach to ventral intradural extramedullary lesions in the subaxial spine up to the cervicothoracic junction. The far-lateral approach can be extended safely to the ventral and ventrolateral lesions of the subaxial cervical spine, especially for recurrent or residual lesions previously approached from the midline posteriorly.
authors.affiliation: Fortis Memorial Research Institute, Gurugram, Haryana, India. Electronic address: drsingh.harnarayan@gmail.com.
authors.forename: Harnarayan
authors.initials: H
authors.lastname: Singh
authors.affiliation: Fortis Memorial Research Institute, Gurugram, Haryana, India.
authors.forename: Rana
authors.initials: R
authors.lastname: Patir
authors.affiliation: Fortis Memorial Research Institute, Gurugram, Haryana, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Vaishya
authors.affiliation: Fortis Memorial Research Institute, Gurugram, Haryana, India.
authors.forename: Anurag
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Fortis Memorial Research Institute, Gurugram, Haryana, India.
authors.forename: Rahul
authors.initials: R
authors.lastname: Miglani
mesh_terms: D000293:Adolescent; D000328:Adult; D016080:Arachnoid Cysts / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D002648:Child; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008577:Meningeal Neoplasms / Q000000981:diagnostic imaging / Q000601:surgery; D008579:Meningioma / Q000000981:diagnostic imaging / Q000601:surgery; D009436:Neural Tube Defects / Q000000981:diagnostic imaging / Q000601:surgery; D019635:Neurosurgical Procedures / Q000379:methods*; D013118:Spinal Cord Diseases / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery
keywords: Arachnoid cyst; Far-lateral approach; Recurrent neurenteric cyst; Subaxial spine