Keywords
Cervical Microsurgery
Cervical Disc Herniation
Cervical Radiculopathy
Cervical Myelopathy
Cervical Stenosis

Definition
The neck can be approached from the front or from behind. From the front, the surgeon must successfully navigate the tissue planes separating vital structures to arrive at the bony surface at the front of the cervical spine. Once the bony surfaces are identified, the surgeon must enter the spinal canal by partial or total disc removal and then visualize the spinal cord and nerve root. In the end, the spinal surgeon must visualize the offending disc or bone spur that compresses nerve or spinal cord, decompress the nerve or spinal cord safely and judge that the operation has fulfilled its intended anatomical objective. From behind, the surgeon approaches the neck to achieve a bloodless plane of dissection, to the posterior bony surfaces and then selectively removes pressure on the spinal nerve by creating a window to assure its freedom along its course or more globally exposes the spinal cord to ensure its freedom. Magnification and illumination are paramount aids in accomplishing the goal of nerve root or spinal cord decompression regardless of approach. The surgeon must establish through experience the exact dimension of hand movement and magnification that provides the greatest judgment and confidence. Illumination is a prerequisite. The combination of visual and tactile skill determine the nuances that approach surgical expertise. In the neck, nothing less is required.

Indications
Cervical Microsurgery is applied to pathologies from either an anterior or posterior approach to the cervical spine.
Technical Considerations Return to Menu
Each change in anatomy has its own technical requirements. The amount of anatomy and surgical tactics determine the technical considerations. All of these potentials are enhanced by magnification and illumination.

Literature Review
The literature references listed below emphasize the variations of pathologies and surgical approaches utilizing the microscope. (ref #1-23)Complications Return to Menu
The complications of cervical microsurgery involve the surgical appraoches and anatomic structures of the intended operation. A wide variety of potentials exist with different pathologies: soft central disc herniation, spondylotic myelopathy, foraminal spur, uncinate spur, soft posterolateral disc herniation, ossification of the posterior longitudinal ligament, tumor, infection, fracture, and dislocation etc.

Author’s Comment
The prinicple of illumination and magnification at the surgical site provide the tools for precision surgery.

References
1: Bucciero A, Vizioli L, Cerillo A. Soft cervical disc herniation. An analysis of 187 cases. J Neurosurg Sci. 1998 Sep;42(3):125-30.
2: Alleyne CH Jr, Cawley CM, Barrow DL, Bonner GD.
Microsurgical anatomy of the dorsal cervical nerve roots and the cervical dorsal root ganglion/ventral root complexes. Surg Neurol. 1998 Sep;50(3):213-8.
3: Petty P. Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures. Neurosurgery. 1997 Jul;41(1):325. No abstract available.
4: Pait TG, Killefer JA, Arnautovic KI. Surgical anatomy of the anterior cervical spine: the disc space, vertebral artery, and associated bony structures. Neurosurgery. 1996 Oct;39(4):769-76.
5: Jho HD. Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg. 1996 Feb;84(2):155-60.
6: Gaetani P, Tancioni F, Spanu G, Rodriguez y Baena R. Anterior cervical discectomy: an analysis on clinical long-term results in 153
cases. J Neurosurg Sci. 1995 Dec;39(4):211-8.
7: Kawano H, Handa Y, Ishii H, Sato K, Oku T, Kubota T.
Surgical treatment for ossification of the posterior longitudinal ligament of the cervical spine. J Spinal Disord. 1995 Apr;8(2):145-50.
8: Seifert V. Anterior decompressive microsurgery and osteosynthesis for the treatment of multi-segmental cervical spondylosis. Pathophysiological considerations, surgical indication, results and complications: a survey. Acta Neurochir (Wien). 1995;135(3-4):105-21. Review.
9: Muhlbauer M, Saringer W, Aichholzer M, Sunder-Plassmann M.
Microsurgical anterior decompression and internal fixation with iliac bone graft and titanium plates for treatment of cervical intervertebral disc herniation. Acta Neurochir (Wien). 1995;134(3-4):207-13.
10: Sachdev VP, Radna RJ. Anterior-approach cervical diskectomy under the operating microscope. Mt Sinai J Med. 1994 May;61(3):233-8.
11: Kubo Y, Waga S, Kojima T, Matsubara T, Kuga Y, Nakagawa Y.
Microsurgical anatomy of the lower cervical spine and cord.
Neurosurgery. 1994 May;34(5):895-90; discussion 901-2.
12: Seifert V, van Krieken FM, Bao SD, Stolke D, Zimmermann M.
Microsurgery of the cervical spine in elderly patients. Part 2: Surgery of
malignant tumourous disease. Acta Neurochir (Wien). 1994;131(3-4):241-6.
13: Seifert V, van Krieken FM, Zimmermann M, Stolke D, Bao SD.
Microsurgery of the cervical spine in elderly patients. Part 1: Surgery of
degenerative disease. Acta Neurochir (Wien). 1994;131(1-2):119-24.
14: Seifert V, Zimmermann M, Stolke D, Wiedemayer H. Spondylectomy, microsurgical decompression and osteosynthesis in the treatment of complex disorders of the cervical spine. Acta Neurochir (Wien). 1993;124(2-4):104-13.
15: Klaiber RD, von Ammon K, Sarioglu AC. Anterior microsurgical approach for degenerative cervical disc disease. Acta Neurochir (Wien). 1992;114(1-2):36-42.
16: Selladurai BM. Cervical myelopathy due to nuclear herniations in young adults: clinical and radiological profile, results of microdiscectomy without interbody fusion. J Neurol Neurosurg Psychiatry. 1992 Jul;55(7):604-8.
17: Yamamoto I, Ikeda A, Shibuya N, Tsugane R, Sato O. Clinical long-term results of anterior discectomy without interbody fusion for cervical disc disease. Spine. 1991 Mar;16(3):272-9.
18: Laus M, Pignatti G, Alfonso C. Extruded cervical disc herniation: treatment with anterior microdiscectomy. Chir Organi Mov. 1990 Jul-Sep;75(3):209-16.
19: Aldrich F. Posterolateral microdisectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg. 1990 Mar;72(3):370-7.
20: Husag L, Probst C. Microsurgical anterior approach to cervical discs. Review of 60 consecutive cases of discectomy without fusion.
Acta Neurochir (Wien). 1984;73(3-4):229-42.
21: Williams RW. Microcervical foraminotomy. A surgical alternative for intractable radicular pain.Spine. 1983 Oct;8(7):708-16.
22: Benini A, Krayenbuhl H, Bruderl R. Anterior cervical discectomy without fusion. Microsurgical technique. Acta Neurochir (Wien). 1982;61(1-3):105-10.
23: Spetzler RF, Roski RA, Selman WR. The microscope in anterior cervical spine surgery. Clin Orthop. 1982 Aug;(168):17-23. No abstract available.