Posterolateral approach to ruptured median and paramedian cervical disk

The trend toward anterior diskectomy for median and paramedian cervical disk rupture has tended to obscure progressive development of the posterolateral approach to these lesions. Modifications of surgical technique from the classic posterior approach have allowed direct access to these lesions, provided for satisfactory decompression of the spinal cord, especially when there is associated spondylosis, and avoided all of the disadvantages of anterior disk surgery. Of 28 patients operated on since 1950, 26 have had significant preoperative myelopathy or myeloradiculopathy. Two patients with obvious spinal cord compression and massive myelographic defects had no neurologic deficit. Improvement has been observed in every patient; 16 patients have had full recovery, and 8 others have had minor residual symptoms and asymptomatic signs. Although four patients have been lost to follow-up, they were all seen at least once after operation. No instance of increased deficit has been seen postoperatively, in contrast to the author's experience with spondylotic myelopathy. Postoperative contrast studies, which have now been performed on eight patients, confirm satisfactory excision of these lesions and decompression.