gms | German Medical Science

Objective: Anteriorly located intraspinal cervical tumors with intraforaminal extension are challenging to approach. When approached from posteriorly, the facets may be compromised or some of the anterior intraforaminal extension may not be reached. When approached with a classical anterior approach, disc replacement has to be considered. As an alternative, the antero-lateral approach allows effective anterior intraspinal and intraforaminal surgery with no need for spinal stabilization. We present two illustrative cases for this technique.

Methods: In 2010, two patients (m 35 and f 18) were operated via the antero-lateral approach. The access was laterally to the jugular vein. By a more oblique trajectory to the neuro-foramen the disc space was avoided. A key point was to control the vertebral artery. Then the foramen was opened. After dural opening, the antero-lateral aspect of the spinal cord was accessible.

Results: The first patient (m 35) had a Ewing sarcoma at C6/C7. After two surgeries via posterior approaches and chemotherapy, a suspect residual intra-foraminal enhancement was resected via the antero-lateral approach. The second patient (f 18) presented with multi-segmental thickened cervical nerve roots resulting in radicular and spinal cord compression. The nerve roots C6 and C7 were biopsied. Histopathological examination found no tumor. In both cases, the approach allowed effective intradural and/ or intraforaminal surgery. Because of minimal bony resection no instrumentation to restore stability was necessary. There was no complication.

Conclusions: The technique presented allowed effective and safe surgery of the anterior intraspinal and intraforaminal region. It was minimally invasive and not compromising spinal stability.