Minimally Invasive Posterior Cervical Diskectomy: Operative Video

Cervical disk protrusion is a common pathology. Anterior diskectomy and fusion is considered the gold standard of treatment, although anterior arthroplasty has gained some acceptance in the past decade as an alternative. Posterior cervical minimally invasive diskectomy is a rarely used technique, and there is less literature discussing this procedure. We have found this technique to be useful in lateral, soft disk herniations not ventral to the cord or mineralized. This avoids an anterior approach with risk to the cervical viscera, the dysphagia associated with an anterior approach, the need for expensive implanted instrumentation, and the need for prolonged activity restrictions after an anterior approach. We include a Video 1 documenting the technique of minimally invasive posterior cervical diskectomy (anatomic landmarks of interest are labeled at several points during the video). This is achieved prone on an OSI Jackson table (Mizuho OSI, Union City, California, USA) without skeletal fixation. A stepwise technique is used to advance an 18-mm tube retractor into contact with the facet and lateral lamina. A 5-mm smooth diamond drill is used to perform a foraminotomy. To avoid nerve root or spinal cord manipulation, it is often necessary to remove some of the rostral aspect of the inferior pedicle to gain access to the axilla and disk protrusion. The procedure is rapid, well tolerated, and performed as outpatient, and it results in a rapid return to normal activity.