Posterolateral approach for anteriorly located cervical spine tumors: technical note

Cervical spinal cord tumors located anteriorly to the spinal cord often require an extensive anterior vertebrectomy approach for their removal followed by bone fusion and postoperative immobilization. To minimize the invasiveness of the conventional anterior approach for those tumors, the author has utilized the anterolateral approach which was originally developed for spondylotic disc disease. However, some of those tumors still can be removed by a less invasive posterior approach which violates spinal integrity to a much lesser degree. Anteriorly located tumors, in which the tumor-cord interface line extends posteriorly to a horizontal line drawn along the posterior margin of the vertebral body, can be removed by the posterolateral approach with a skin incision made at the point where the tumor-cord line intersects. Because the facet joint is thin and the pedicle is shallow in the cervical spine, only a hemilaminectomy bone window is required in this posterolateral approach for removal of such tumors. Surgical techniques of this posterolateral approach for removal of anteriorly located cervical cord tumors are described with two illustrated patients.