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

Tyler Scullen1,2, Christina Ng1,2, Mansour Mathkour1,2

  • 1Department of Neurological Surgery, Ochsner Clinic Foundation, Jefferson, Louisiana, USA.

Operative Neurosurgery (Hagerstown, Md.)
|May 11, 2023
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Posterolateral approaches to the ventral subaxial cervical spine improve surgical access. Complex osteotomies significantly increase working angles and visualization of ventral spinal axis structures.

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).

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  • 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.