Minimally Invasive Posterior Cervical Fixation

  • Larry T. KhooEmail author
  • Zachary A. Smith
  • Roya Gheissari


Posterior fixation techniques continue to play a vital part in the treatment of cervical spine pathology. Evolving from semirigid techniques such as wiring to dynamic screw-plate constructs, modern techniques employing screw rod constructs now allow for far more robust stabilization after cervical decompression. Additionally, interfacet and transfacet techniques have further added to the armamentarium available to surgeons to achieve rigid arthrodesis and maintainance of correction. With the implementation of minimally invasive tissue-sparing techniques during posterior cervical instrumentation, significant improvements in soft tissue morbidity, blood loss, pain, recovery, return to work, infection, and reoperation rates have also been observed and documented. Contemporary three-dimensional intraoperative imaging techniques also provide enhanced accuracy and localization during instrumentation of the posterior cervical anatomy. When used with newer perioperative pharmaceutical and anesthetic protocols as well as with modern intraoperative neurmonitoring modalities such as motor evoked potentials, the combination of these surgical technologies has served to greatly enhance the efficacy, safety,,accuracy, and outcomes of posterior surgical decompressive and instrumentation procedures.


Posterior cervical instrumentation Minimally invasive rigid posterior cervical decompression Transfacet and intrafacet cervical instrumentation Intraoperative posterior cervical imaging and guidance Intraoperative posterior cervical neurophysiological monitoring Posterior cervical perioperative anesthetic protocols 


  1. 1.
    Aebi M, Thalgott JS, Webb JK, Goytan M, Jeanneret B. AO ASIF principles in spine surgery. New York: Springer; 1998.CrossRefGoogle Scholar
  2. 2.
    Chapman JR, Anderson PA, Pepin C, Toomey S, Newell DW, Grady MS. Posterior Instrumentation of the unstable cervicothoracic spine. J Neurosurg. 1996;84:552–8.CrossRefGoogle Scholar
  3. 3.
    Bohlman HH. Acute fractures and dislocations of the cervical spine. An analysis of three hundred hospitalized patients and review of the literature. J Bone Joint Surg Am. 1979;61:1119–42.CrossRefGoogle Scholar
  4. 4.
    Cahill DW, Bellegarrigue R, Ducker TB. Bilateral facet to spinous process fusion: a new technique for posterior spinal fusion after trauma. Neurosurgery. 1983;13:1–4.CrossRefGoogle Scholar
  5. 5.
    Callahan RA, Johnson RM, Margolis RN, Keggi KJ, Albright JA, Southwick WO. Cervical facet fusion for control of instability following laminectomy. J Bone Joint Surg Am. 1977;59:991–1002.CrossRefGoogle Scholar
  6. 6.
    McAfee PC, Bohlman HH, Wilson WL. Triple wire technique for stabilization of acute cervical fracture dislocation. Orthop Trans. 1986;10:455–6.Google Scholar
  7. 7.
    Perin NL, Cusick JF. Interspinous, lamina, and facet fusion. In: Benzel E, editor. Spine surgery: techniques, complication avoidance, and management. Philadelphia: Churchill Livingstone; 1999. p. 257–63.Google Scholar
  8. 8.
    Stauffer ES. Wiring techniques of the posterior cervical spine for the treatment of trauma. Orthopedics. 1988;11:1543–8.PubMedGoogle Scholar
  9. 9.
    Sutterlin CE 3rd, McAfee PC, Warden KE, Rey RM Jr, Farey ID. A biomechanical evaluation of cervical spinal stabilization methods in a bovine model. Static and cyclical loading. Spine. 1988;13:795–802.CrossRefGoogle Scholar
  10. 10.
    Coe JD, Warden KE, Sutterlin CE 3rd, McAfee PC. Biomechanical evaluation of cervical spinal stabilization methods in a human cadaveric model. Spine. 1989;14:1122–31.CrossRefGoogle Scholar
  11. 11.
    Maurer PK, Ellenbogen RG, Ecklund J, Simonds GR, van Dam B, Ondra SL. Cervical spondylotic myelopathy: treatment with posterior decompression and Luque rectangle bone fusion. Neurosurgery. 1991;28:680–3.CrossRefGoogle Scholar
  12. 12.
    Roy-Camille R, et al. Early management of spinal injuries. In: McKibbin B, editor. Recent advances in orthopedics. Edinburgh: Churchill Livingstone; 1979. p. 57–87.Google Scholar
  13. 13.
    Roy-Camille R, et al. Internal fixation of the unstable cervical spine by posterior osteosynthesis with plates and screws. In: The Cervical Spine Research Society Editorial Committee, editor. The cervical spine. 2nd ed. Philadelphia: Lippincott-Raven; 1989. p. 390–404.Google Scholar
  14. 14.
    Benzel EC. Construct design. In: Benzel E, editor. Biomechanics of spine stabilization: principles and clinical practice. New York: McGraw-Hill; 1995. p. 163–72.Google Scholar
  15. 15.
    Cooper PR, Cohen A, Rosiello A, Koslow M. Posterior stabilization of cervical spine fractures and subluxations using plates and screws. Neurosurgery. 1988;23:300–6.CrossRefGoogle Scholar
  16. 16.
    Gill K, Paschal S, Corin J, Ashman R, Bucholz RW. Posterior plating of the cervical spine. A biomechanical comparison of different posterior fusion techniques. Spine. 1988;13:813–6.CrossRefGoogle Scholar
  17. 17.
    White AA, Panjabi MM. Biomechanical considerations in the surgical management of the spine. In: White A, Panjabi M, editors. Clinical biomechanics of the spine. 2nd ed. Philadelphia: Lippincott-Raven; 1990. p. 511–639.Google Scholar
  18. 18.
    Ebraheim NA, An HS, Jackson WT, Brown JA. Internal fixation of the unstable cervical spine using posterior Roy-Camille plates: preliminary report. J Orthop Trauma. 1989;3:23–8.CrossRefGoogle Scholar
  19. 19.
    Khoo L, et al. Biomechanical comparison of fixation techniques across the cervicothoracic junction. Presented at annual meeting of North American Spine Society, New Orleans, 2000.Google Scholar
  20. 20.
    An HS, Vaccaro A, Cotler JM, Lin S. Spinal disorders at the cervicothoracic junction. Spine. 1994;19:2557–64.CrossRefGoogle Scholar
  21. 21.
    Dekutoski MB, Schendel MJ, Ogilvie JW, Olsewski JM, Wallace LJ, Lewis JL. Comparison of in vivo and in vitro adjacent segment motion after lumbar fusion. Spine. 1994;19:1745–51.CrossRefGoogle Scholar
  22. 22.
    Delamarter RB, et al. The C7-T1 junction: problems with diagnosis, visualization, instability and decompression. Orthop Trans. 1989;13:218.Google Scholar
  23. 23.
    Evans DK. Dislocations at the cervicothoracic junction. J Bone Joint Surg Br. 1983;65:124–7.CrossRefGoogle Scholar
  24. 24.
    Kramer DL, et al. Placement of pedicle screws in the cervical spine: comparative accuracy of cervical pedicle screw placement using three techniques. Orthop Trans. 1997;21:496.Google Scholar
  25. 25.
    Panjabi MM, Duranceau J, Goel V, Oxland T, Takata K. Cervical human vertebrae. Quantitative three-dimensional anatomy of the middle and lower regions. Spine. 1991;16:861–9.CrossRefGoogle Scholar
  26. 26.
    Stanescu S, Ebraheim NA, Yeasting R, Bailey AS, Jackson WT. Morphometric evaluation of the cervico-thoracic junction. Practical considerations for posterior fixation of the spine. Spine. 1994;19:2082–8.CrossRefGoogle Scholar
  27. 27.
    Kotani Y, Cunningham BW, Abumi K, McAfee PC. Biomechanical analysis of cervical stabilization systems. An assessment of transpedicular screw fixation in the cervical spine. Spine. 1994;19:2529–39.CrossRefGoogle Scholar
  28. 28.
    Aldrich F. Posterolateral microdisectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg. 1990;72:370–7.CrossRefGoogle Scholar
  29. 29.
    Henderson CM, Hennessy RG, Shuey HM Jr, Shackelford EG. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983;13:504–12.CrossRefGoogle Scholar
  30. 30.
    Krupp W, Schattke H, Müke R. Clinical results of the foraminotomy as described by Frykholm for the treatment of lateral cervical disc herniation. Acta Neurochir. 1990;107:22–9.CrossRefGoogle Scholar
  31. 31.
    Murphey F, Simmons JC, Brunson B. Surgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939 to 1972. J Neurosurg. 1973;38:679–83.CrossRefGoogle Scholar
  32. 32.
    Odom GL, Finney W, Woodhall B. Cervical disk lesions. J Am Med Assoc. 1958;166:23–8.CrossRefGoogle Scholar
  33. 33.
    Roh SW, Kim DH, Cardoso AC, Fessler RG. Endoscopic foraminotomy using MED system in cadaveric specimens. Spine. 2000;25:260–4.CrossRefGoogle Scholar
  34. 34.
    Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery. 2002;51:S37–45.Google Scholar
  35. 35.
    Khoo L. Minimally-invasive posterior decompression and fixation of cervical jumped facets: an initial clinical experience in 11 patients. Presented at annual meeting of the AANS/CNS section on disorders of the spine and peripheral nerves, Tampa. 2003.Google Scholar
  36. 36.
    Wang MY, Prusmack CJ, Green BA, Gruen JP, Levi AD. Minimally invasive lateral mass screws in the treatment of cervical facet dislocations: technical note. Neurosurgery. 2003;52:444–7.CrossRefGoogle Scholar
  37. 37.
    McCormack BM, Bundoc R, Ver MR, Ignacio JM, Berven SH, Eyster EF. Percutaneous posterior cervical fusion with the DTRAX Facet System for single-level radiculopathy: results in 60 patients. J Neurosurg Spine. 2013 Mar;18(3):245–54.CrossRefGoogle Scholar
  38. 38.
    Smith W, Gillespy M, Huffman J, Vong V, McCormack BM. Anterior cervical pseudarthrosis treated with bilateral posterior cervical cages. Oper Neurosurg. 2018;14(3):236–42.CrossRefGoogle Scholar
  39. 39.
    Grob D, Magerl F. Dorsal spondylodesis of the cervical spine using a hooked plate. Orthopade. 1987;16:55–61.PubMedGoogle Scholar
  40. 40.
    Haid RW, et al. Lateral mass plating for cervical instability. Presented at congress of neurological surgeons, Los Angeles. 1990.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Larry T. Khoo
    • 1
    Email author
  • Zachary A. Smith
    • 2
  • Roya Gheissari
    • 1
  1. 1.The Spine Clinic of Los Angeles, University of Southern California Neuroscience Center at Good Samaritan HospitalLos AngelesUSA
  2. 2.Department of Neurological SurgeryFeinberg School of Medicine of Northwestern UniversityChicagoUSA

Personalised recommendations