Minimally invasive approach to the cervical spine: a proposal

BACKGROUND andPURPOSE: During the last 3 years, a minimally invasive\r\nvideo-assisted approach for parathyroidectomy and thyroidectomy has been\r\ndeveloped. Because of the good exposure of the cervical spine during these\r\nprocedures, the authors decided to perform an anatomic-radiologic study in order \r\nto evaluate which cervical vertebrae could be reached by this minimally invasive \r\napproach. PATIENTS and\r\nMETHODS: Three consenting patients, two undergoing minimally invasive\r\nparathyroidectomy and one a conventional operation for C4-C5 disc herniation,\r\nwere selected for this study. The procedure was carried out through a single\r\n1.5-cm central skin incision above the sternal notch. After opening of the\r\ncervical linea alba, dissection was performed under endoscopic vision, without\r\nusing any CO2 insufflation or trocar. After exposure of the prevertebral fascia, \r\nan operative tube was introduced through the cervical incision in order to\r\nmaintain the operative space without using conventional retractors.\r\nRESULTS: Through this operative tube, it was possible to introduce both a 5-mm\r\n(or 3-mm) endoscope and the surgical instruments. In our patients, we inserted a \r\n1-mm metal probe to exactly localize during fluoroscopy the vertebrae reached by \r\nthe dissection (C2-C7).\r\nCONCLUSIONS: This study shows the feasibility of an anterior minimally invasive\r\napproach to the cervical spine. Although the exact indications have to be\r\nverified, a video-assisted approach could add some advantages to the well-known\r\nbenefits coming from the anterior approaches to the cervical spine, especially in\r\nterms of cosmetic results and postoperative course and recovery.