Ventral Subaxial Cervical Access Using Tailored Access Osteotomies, A Cadaveric Study.
Oper Neurosurg (Hagerstown)
; 25(1): 87-94, 2023 07 01.
Article
em En
| MEDLINE
| ID: mdl-37166193
ABSTRACT
BACKGROUND:
Ventral lesions of the subaxial cervical spine are challenging because approaches must circumvent endodermal and neurovascular structures.OBJECTIVE:
To use cadaveric study to describe 4 posterolateral approaches to the ventral subaxial cervical spine with various facilitating techniques and osteotomies.METHODS:
Three cadaveric specimens of the cervical spine were sequentially subjected to multilevel laminectomy (Type 1), transfacet (Type 2), transpedicular (Type 3), and extreme lateral transforaminal (Type 4) approaches. Approach working angles and proportion of visualized zones were compared, the former calculated using trigonometric methods.RESULTS:
There was a significant stepwise increase in working angle in the ventral space, associated with increasing osteotomy type, from an average of 3.7° in single-level type 1 to 19.47° in the type 4 osteotomy. Regarding anatomic zones, proportional partial and total visualization achieved with Type 2 to 4 approaches were significantly greater than with Type 1. Complex osteotomies allowed superior access to be obtained to contributing and adjacent vessels of the ventral spinal axis.CONCLUSION:
Ventral subaxial cervical lesions are difficult to access. We report increased working angles using quantified cadaveric data in increasingly complex posterior and posterolateral approaches graded as type 1 through 4. We advocate continued translational research in such approaches to lesions often considered to lie in surgically inaccessible locations.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Osteotomia
/
Laminectomia
Limite:
Humans
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article