European Spine Journal

, Volume 27, Issue 6, pp 1349–1357 | Cite as

A novel posterior approach preserving three muscles inserted at C2 in multilevel cervical posterior decompression and fusion using C2 pedicle screws

  • Kazunari Takeuchi
  • Toru Yokoyama
  • Takuya Numasawa
  • Taito Itabashi
  • Yoshihito Yamasaki
  • Hitoshi Kudo
Original Article



To present a novel posterior approach in multilevel cervical posterior decompression and fusion (PDF) using C2 pedicle screws that preserves the rectus capitis posterior major, oblique capitis inferior, and semispinalis cervicis.


We analyzed 30 consecutive patients who underwent C2–T1 PDF using an approach that preserved these three muscles without resecting. We assessed O-C2 range of motion (ROM), cross-sectional area of the cervical posterior muscles, rotational ROM, visual analog scale (VAS) for axial pain, neck disability index (NDI), and limitations of activities of daily living (ADL) involving neck movements.


Mean preoperative O-C2 ROM (23.6°) was significantly increased postoperatively (33.0°). Mean atrophy rate of the cross-sectional area was 3.9%. Postoperatively, 69.8% of the preoperative rotational ROM (113.3°) was retained. The preoperative VAS for axial pain and the NDI did not increase postoperatively. The postoperative O-C2 ROM (33.9°) in 26 patients for whom extension ADL were possible was significantly larger than that in four patients for whom extension ADL were impossible (26.9°). The postoperative retained rate of rotational ROM (75.8%) in 18 patients for whom rotation ADL were possible was significantly larger than that in 12 patients for whom rotation ADL were impossible (62.3%).


This is potentially an effective approach for maintaining O-C2 ROM and rotational ROM, which enabled good levels of ADL after C2–T1 PDF. Axial pain and NDI were not worse after PDF.


Posterior decompression and fusion Posterior approach Muscle preservation Range of motion Ossification of the posterior longitudinal ligament 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2017

Authors and Affiliations

  • Kazunari Takeuchi
    • 1
  • Toru Yokoyama
    • 1
  • Takuya Numasawa
    • 2
  • Taito Itabashi
    • 3
  • Yoshihito Yamasaki
    • 4
  • Hitoshi Kudo
    • 5
  1. 1.Department of Orthopedic SurgeryOdate Municipal General HospitalOdateJapan
  2. 2.Department of Orthopedic SurgeryHachinohe City HospitalHachinoheJapan
  3. 3.Department of Orthopedic SurgeryTowada City HospitalTowadaJapan
  4. 4.Department of Orthopedic SurgeryAomori City HospitalAomoriJapan
  5. 5.Department of Orthopaedic SurgeryHirosaki University School of MedicineHirosakiJapan

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