Posterior Cervical Decompression

The posterior cervical approach is useful in cases of radicular arm pain due to herniations that are lateral to the border of the spinal cord, or for stenosis of the intervertebral foraminal. Herniations medial to the lateral border of the spinal cord cannot be addressed with this approach because the spinal cord must not be manipulated. Any craniocaudal sequestration must not exceed half of the height of the vertebral body.

The instrumentation for the posterior cervical approach includes the short spine endoscope with 3 mm working channel and the motorized burr system. Because of the very small natural opening between laminae of adjacent segments, the burr system must be used to create access.

Technique Summary:

  • The access path is directly posterior over the zygapophyseal joint
  • Incise the skin and insert the dilator down to the joint then place the working sleeve over the dilator
  • Introduce the endoscope into the working sleeve
  • Use burrs and bone punches to create an access window by partially resecting the laminae and medial facet
  • Remove the lateral ligamentum flavum and visualize the dura and exiting nerve root
  • Use instruments to remove the herniation and decompress the nerve