Posterior Cervical Decompression

Abstract

Posterior cervical decompression is an effective technique for treatment of cervical radiculopathy from various sources of central and foraminal stenosis such as herniated nucleus pulposus, osteophytes, and other degenerative changes. For the surgical treatment of cervical radiculopathy, options include both anterior and posterior procedures. Posterior decompressive procedures have the advantage of preserving motion and decreasing the long-term sequelae of anterior fusions such as adjacent segment degeneration. Posterior cervical decompressive procedures also avoid the approach-related complications of anterior procedures such as esophageal injury, vascular injury, recurrent laryngeal nerve paralysis, and postoperative dysphagia.

Minimally invasive posterior surgical techniques have recently been developed to mitigate the extensive stripping of paraspinal musculature necessary in open posterior cervical approaches which can result in significant postoperative pain or muscle spasm. Clinical results of minimally invasive posterior cervical foraminotomy have shown equivalent efficacy with a reduction in blood loss, length of stay, and postoperative pain compared to open surgery. Minimally invasive foraminotomy has also been shown to achieve equivalent decompression compared to open techniques in cadaveric models and shown to require less surgical time than an anterior cervical discectomy and fusion. This chapter will review the technique of posterior cervical decompression using a minimally invasive tubular retractor system.