Minimally Invasive Cervical Pedicle Screw Fixation (MICEPS) via a Posterolateral Approach

Cervical pedicle screw (PS) fixation provides great mechanical strength; however, it needs wide soft tissue detachment and has vertebral artery damage risk. Minimally invasive cervical pedicle screw (MICEPS) fixation, a new method for cervical PS fixation through a posterolateral approach, was developed to reduce soft tissue damage and avoid lateral misplacement of screws. Sixty-seven patients with cervical injury underwent MICEPS fixation. They were positioned prone on a radiolucent carbon table with a carbon Mayfield frame. A reference frame was attached to the spinous process through a small skin incision. One or 2 lateral incisions were made for screw insertion under navigation guidance. After the nuchal fascia was cut, the lateral mass was exposed with blunt dissection between the levator scapulae and splenius muscles. A self-retaining tubular retractor with illumination was applied between split muscle fibers. A 1.4-mm K-wire was inserted using an electric driver under navigation guidance. Drill and tap and cannulated PSs were sequentially inserted over the K-wire; facet fusion via bone grafting can be performed at this time. The rod was placed to the screw head. This technique can reduce intraoperative bleeding and screw deviation rate, with neither of the misplaced screws deviating laterally in the MICEPS group.