Ventral Subaxial Cervical Access Using Tailored Access Osteotomies, A Cadaveric Study

Area of Science:

• Neurosurgery
• Spinal Anatomy
• Surgical Techniques

Background:

• Ventral subaxial cervical spine lesions present surgical challenges due to the need to avoid critical endodermal and neurovascular structures.
• Accessing these ventral lesions requires careful consideration of anatomical constraints.

Purpose of the Study:

• To describe four posterolateral approaches to the ventral subaxial cervical spine using cadaveric specimens.
• To evaluate the effectiveness of various facilitating techniques and osteotomies in improving surgical access.

Main Methods:

• Three cadaveric cervical spine specimens were utilized.
• Four sequential approaches were performed: multilevel laminectomy (Type 1), transfacet (Type 2), transpedicular (Type 3), and extreme lateral transforaminal (Type 4).
• Working angles and visualized zones were quantified using trigonometric methods and direct comparison.

Main Results:

• A significant stepwise increase in working angle was observed with increasing osteotomy complexity, from 3.7° (Type 1) to 19.47° (Type 4).
• Approaches Type 2 through 4 provided significantly greater visualization of ventral and adjacent anatomical zones compared to Type 1.
• Complex osteotomies facilitated superior access to the ventral spinal axis, including critical vascular structures.

Conclusions:

• Posterior and posterolateral approaches, graded from Type 1 to 4, offer progressively improved working angles and visualization for ventral subaxial cervical lesions.
• These findings support the development of translational research for surgical approaches to challenging, often inaccessible, spinal locations.