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Published Online: 7 July 2004

Minimally Invasive Approach to the Cervical Spine: A Proposal

Publication: Journal of Laparoendoscopic & Advanced Surgical Techniques
Volume 11, Issue Number 2

Abstract

Background and Purpose: During the last 3 years, a minimally invasive video-assisted approach for parathyroidectomy and thyroidectomy has been developed. Because of the good exposure of the cervical spine during these procedures, the authors decided to perform an anatomic-radiologic study in order to evaluate which cervical vertebrae could be reached by this minimally invasive approach.
Patients and Methods: Three consenting patients, two undergoing minimally invasive parathyroidectomy and one a conventional operation for C4-C5 disc herniation, were selected for this study. The procedure was carried out through a single 1.5-cm central skin incision above the sternal notch. After opening of the cervical linea alba, dissection was performed under endoscopic vision, without using any CO2 insufflation or trocar. After exposure of the prevertebral fascia, an operative tube was introduced through the cervical incision in order to maintain the operative space without using conventional 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 inserted a 1-mm metal probe to exactly localize during fluoroscopy the vertebrae reached by the dissection (C2-C7).
Conclusions: This study shows the feasibility of an anterior minimally invasive approach to the cervical spine. Although the exact indications have to be verified, a video-assisted approach could add some advantages to the well-known benefits coming from the anterior approaches to the cervical spine, especially in terms of cosmetic results and postoperative course and recovery.

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cover image Journal of Laparoendoscopic & Advanced Surgical Techniques
Journal of Laparoendoscopic & Advanced Surgical Techniques
Volume 11Issue Number 2April 2001
Pages: 89 - 92
PubMed: 11327133

History

Published online: 7 July 2004
Published in print: April 2001

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Paolo Miccoli
Department of Surgery, University of Pisa, Pisa, Italy.
Piero Berti
Department of Surgery, University of Pisa, Pisa, Italy.
Marco Raffaelli
Department of Surgery, University of Pisa, Pisa, Italy.
Gabriele Materazzi
Department of Surgery, University of Pisa, Pisa, Italy.
Massimo Conte
Department of Surgery, University of Pisa, Pisa, Italy.
Alessandro Faldini
Department of Orthopedics, University of Pisa, Pisa, Italy.

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