Background and Purpose: During the last 3 years, a minimally invasive video-assisted approach for parathyroidectomy and thyroidectomy has been developed. Because of the good exposure of the cervical spine during these procedures, the authors decided to perform an anatomic-radiologic study in order to evaluate which cervical vertebrae could be reached by this minimally invasive approach. Patients and Methods: Three consenting patients, two undergoing minimally invasive parathyroidectomy and one a conventional operation for C 4-C 5 disc herniation, were selected for this study. The procedure was carried out through a single 1.5-cm central skin incision above the sternal notch. After opening of the cervical linea alba, dissection was performed under endoscopic vision, without using any CO 2 insufflation or trocar. After exposure of the prevertebral fascia, an operative tube was introduced through the cervical incision in order to maintain the operative space without using conventional retractors. Results: Through this operative tube, it was possible to introduce both a 5-mm (or 3-mm) endoscope and the surgical instruments. In our patients, we inserted a 1-mm metal probe to exactly localize during fluoroscopy the vertebrae reached by the dissection (C 2-C 7). Conclusions: This study shows the feasibility of an anterior minimally invasive approach to the cervical spine. Although the exact indications have to be verified, a video-assisted approach could add some advantages to the well-known benefits coming from the anterior approaches to the cervical spine, especially in terms of cosmetic results and postoperative course and recovery.
Minimally invasive approach to the cervical spine: a proposal
MICCOLI, PAOLO;BERTI, PIERO;RAFFAELLI, MARCO;MATERAZZI, GABRIELE;FALDINI, ALESSANDRO
2001-01-01
Abstract
Background and Purpose: During the last 3 years, a minimally invasive video-assisted approach for parathyroidectomy and thyroidectomy has been developed. Because of the good exposure of the cervical spine during these procedures, the authors decided to perform an anatomic-radiologic study in order to evaluate which cervical vertebrae could be reached by this minimally invasive approach. Patients and Methods: Three consenting patients, two undergoing minimally invasive parathyroidectomy and one a conventional operation for C 4-C 5 disc herniation, were selected for this study. The procedure was carried out through a single 1.5-cm central skin incision above the sternal notch. After opening of the cervical linea alba, dissection was performed under endoscopic vision, without using any CO 2 insufflation or trocar. After exposure of the prevertebral fascia, an operative tube was introduced through the cervical incision in order to maintain the operative space without using conventional retractors. Results: Through this operative tube, it was possible to introduce both a 5-mm (or 3-mm) endoscope and the surgical instruments. In our patients, we inserted a 1-mm metal probe to exactly localize during fluoroscopy the vertebrae reached by the dissection (C 2-C 7). Conclusions: This study shows the feasibility of an anterior minimally invasive approach to the cervical spine. Although the exact indications have to be verified, a video-assisted approach could add some advantages to the well-known benefits coming from the anterior approaches to the cervical spine, especially in terms of cosmetic results and postoperative course and recovery.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
