ABSTRACT
Access to the anterior cervical spinal canal is obstructed by the spinal cord and nerve roots posteriorly, the cervical musculature and vessels laterally, and the vertebral bodies anteriorly. Surgical approaches to lesions affecting the ventral compartment of these regions fall into two categories: (i) anterior approaches and (ii) posterolateral approaches. Anterior approaches across multiple levels, however, provide only a deep and narrow exposure and are of limited use in resecting lesions that extend over more than two levels or that involve significant lateral extension. Cervical posterolateral approaches allow for visualization of the ventral spinal canal across multiple levels, but require extensive resection of the posterior bony elements and pedicles (1,2,3). Reconstruction after posterolateral approaches, therefore, is often problematic in that three-column stabilization has not traditionally been possible across levels at which a pediculectomy has been performed. As such, lesions of the ventral cervical spinal compartment have proven difficult to access from posterior surgical approaches. We describe in detail the anatomic and surgical principles of a lateral cervical paramedian transpedicular approach-a novel technique that provides access to the ventral cervical spinal canal. This technique is a modification of traditional thoracic posterolateral extracavitary approaches. We also describe single-stage posterior column reconstruction of the cervical spine in which traditional cervical lateral mass screws are used to simultaneously reconstruct the cervical pedicle and allow for three-column stabilization in a continuous posterior screw-rod construct after this approach. Thus, cervical spinal stability is enhanced, as all cervical levels are incorporated into the final screw-rod construct.
