Minimally Invasive Cervical Pedicle Screw Placement With a Freehand Technique Through the Posterolateral Approach Using a Tubular Retractor: A Technical Note

BACKGROUND AND IMPORTANCE: Although many studies have demonstrated the biomechanical superiority of cervical pedicle screw (CPS) placement with sufficient safety and accuracy, it also has an inevitable major drawback in that an extensive posterior neck muscle dissection results in immediate postoperative neck pain. To avoid this disadvantage and highlight the several biomechanical advantages of CPS, we conducted the first minimally invasive surgery using both a tubular retractor through the posterolateral approach and a freehand placement technique. CLINICAL PRESENTATION: A 77-yr-old man presented with quadriparesis and neck pain. The diagnosis was infectious discitis with ventral epidural abscess extending from C6 to T1. The surgery was performed in 2 steps. First, CPSs were inserted bilaterally in C6 and C7 with a freehand technique through the tubular retractor, and posterolateral fusion was performed with cancellous iliac bone chips after 2 rod connections. Second, C6-7 discectomy with partial upper bony resection of the C7 body was performed through an anterior approach. Anterior interbody fusion was performed with only iliac bone block, without plate fixation. The patient could sit without serious neck pain immediately postoperatively, and ambulation was possible the next day after surgery. Postoperative magnetic resonance images showed complete bilateral preservation of the semispinalis cervicis muscles. Six months after operation, dynamic radiographs showed stability and the visual analogue scale score for neck pain was 1 point. CONCLUSION: We report on an advantageous minimally invasive approach combined with the freehand technique for the preservation of the posterior ligamentous complex and muscles during CPS placement.