Surgical Techniques: Subaxial Cervical—Modified Subaxial Paramedian Transpedicular Approach and Reconstruction

Abstract

Ventrally located cervical spinal tumors present barriers to safe and efficacious surgical resection. The modified paramedian transpedicular approach with reconstruction was originally developed for ventral and ventrolaterally located intradural tumors spanning several segments in the cervical and cervicothoracic spine. Thus, in the subaxial cervical spine, this approach allows for a direct tumor visualization via a wide exposure secondary to bony removal with minimal spinal cord manipulation.

In the anterior transcervical extrapharyngeal approach, the surgical corridor is narrow and deep, and not ideal for lateral lesions or lesions that extend more than two levels. In addition, the anterior approach carries with it risk of pharynx violation and retraction of the laryngeal nerves. The posterolateral approach allows for early visualization of the thecal sac and nerve roots, as well as mobilization of the vertebral artery. It is ideal for tumors that extend across the midline and cannot be easily accessed via an anterior approach or traditional posterior facetectomy.