Minimally invasive approach to the cervical spine: A proposal

Background and Purpose: During the last 3 years, a minimally invasive video -assisted approach for parathyroidectomy and thyroidectomy has been develop ed. Because of the good exposure of the cervical spine during these procedu res, the authors decided to perform an anatomic-radiologic study in order t o evaluate which cervical vertebrae could be reached by this minimally inva sive approach. Patients and Methods: Three consenting patients, two undergoing minimally i nvasive parathyroidectomy and one a conventional operation for C-4-C-5 disc herniation, were selected for this study. The procedure was carried out th rough a single 1.5-cm central skin incision above the sternal notch. After opening of the cervical linea alba, dissection was performed under endoscop ic vision, without using any CO2 insufflation or trocar. After exposure of the prevertebral fascia, an operative tube was introduced through the cervi cal incision in order to maintain the operative space without using convent ional retractors. Results: Through this operative tube, it was possible to introduce both a 5 -mm (or 3-mm) endoscope and the surgical instruments. In our patients, we i nserted a 1-mm metal probe to exactly localize during fluoroscopy the verte brae reached by the dissection (C-2-C-7). Conclusions: This study shows the feasibility of an anterior minimally inva sive approach to the cervical spine. Although the exact indications have to be verified, a video-assisted approach could add some advantages to the we ll-known benefits coming from the anterior approaches to the cervical spine , especially in terms of cosmetic results and postoperative course and reco very.