Minimally Invasive Techniques for the Posterior Cervical Spine: Foraminal Decompression and Instrumented Fusion

Minimally invasive surgical techniques have been adopted to treat conditions in the posterior cervical spine. Through specialized tubular retraction systems and proper technique, multilevel posterior cervical foraminal decompression and instrumented fusion can be accomplished though a single incision. In this report we describe the techniques to perform both cervical foraminotomy and lateral mass fixation at 3 or more levels through an expanding tubular retractor. Complications may include inadequate decompression, poor placement of instrumentation, neurologic injury, or iatrogenic postoperative instability. Preoperative planning and careful technique can help avoid specific complications related to tubular access and poor visualization. The surgeon must always be prepared to convert to a traditional open procedure if an adequate decompression and/or fusion cannot be performed because of difficulties related to visualization, distorted anatomy, or improper access.