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Minimally Invasive Cervical Spine Foraminotomy and Lateral Mass Screw Placement

Mikhael, Mark M. MD*; Celestre, Paul C. MD*; Wolf, Christopher F. MD*; Mroz, Tom E. MD; Wang, Jeffrey C. MD*

doi: 10.1097/BRS.0b013e31823a43f9
SRS Focus Issue

Study Design. 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.

Summary of Background Data. 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.

Conclusion. 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.

Minimally invasive multilevel posterior cervical foraminotomy and instrumented fusion using lateral mass screw fixation can be safely achieved using tubular retraction systems. Complications associated with these strategies are typically due to inadequate visualization, incomplete decompression, or poor placement of instrumentation.

*Department of Orthopedic Surgery, UCLA Comprehensive Spine Center, Santa Monica, CA

Department of Orthopedic Surgery, The Cleveland Clinic Foundation, Cleveland, OH.

Address correspondence and reprint requests to Mark M. Mikhael, MD, UCLA Comprehensive Spine Center, 1250 16th Street, Suite 745, Santa Monica, CA 90404; E-mail: MMikhael@mednet.ucla.edu

Acknowledgment date: January 10, 2011. Acceptance date: September 28, 2011.

The device(s)/drug(s) is/are FDA approved or approved by the corresponding national agency for this indication.

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

© 2012 Lippincott Williams & Wilkins, Inc.