Keisuke Onoda*, Junpei Kato, Akira Saitoh, Shuhei Yamasaki, Ryohei Sashida, Tomihiro Wakamiya, Mssahiro Indou, Tatsuya Tanaka, Takashi Agari, Takashi Sugawara, Kazuaki Shimoji, Eiichi Suehiro, Kimihiro Nakahara, Hiroshi Itokawa and Akira Matsuno

Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124, Japan

*Corresponding Author: Keisuke Onoda, Department of Neurosurgery, International University of Health and Welfare, School of Medicine, Narita Hospital, 852 Hatakeda, Narita, Chiba 286-0124, Japan.

Received: July 08, 2025; Published: July 16, 2025

Abstract

Introduction: Anterior fixation using the iliac crest graft or a cage is the standard technique for accessing anterior cervical spine. However, it limits cervical motion and puts strain on adjacent discs, potentially leading to new lesions. The primary aim of anterior oblique keyhole approach is to treat anterior spinal cord disorders directly without requiring fusion manipulation. This approach can also be used for multilevel lesions. In this study, we report the advantages and effectiveness of this approach in 10 cases.

Methods: A total of 10 cases were included in the study, 7 males and 3 females, with mean age of 57.1 years. All cases had anterior spinal cord lesions: two with herniated discs, seven with cervical spondylosis, and one with ossification of the posterior longitudinal ligament (OPLL). Treated intervertebral levels involved one disc in one case, two discs in seven cases, and 3 discs in two cases. Pre- and postoperative neurological symptoms were assessed by neurosurgical cervical spine scale (NCSS). The operation was performed by creating a groove with an air drill from the anterolateral aspect of the vertebral body, followed by drilling deep into the vertebral body to directly reach directly the lesion. By extracting it, the spinal cord was decompressed. Lastly, the skin is sutured to end the surgery,

Results: The average operative time was 91 minutes, with minimal blood loss. After surgery, all patients showed improvement in symptoms immediately, and no complications were observed. This approach did not require fusion manipulation and did not cause postoperative limitation of cervical motion. Moreover, no postoperative cervical deformity was observed.

Conclusion: The approach was minimally invasive and did cause impairment or complications due to strain on adjacent intervertebral discs, making it suitable for elderly patients who aim to improve their quality of life. However, long-term follow-up is necessary, and further studies should be conducted to carefully evaluate other possible factors.

Keywords: Anterior Oblique Keyhole Approach; Antero-Lateral Partial Vertebrectomy; Spinal Lesions; Cervical Fusion; Spine Decompression

References

1. McCarthy MH., et al. “Strategies to achieve spinal fusion in multilevel anterior cervical spine surgery: An overview”. HSS Journal1 (2020): 155-161.
2. Hilibrand AS., et al. “Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis”. Journal of Bone and Joint Surgery – American Volume4 (1999): 519-528.
3. Goffin J., et al. “Long-term follow-up after interbody fusion of the cervical spine”. Journal of Spinal Disorders and Techniques 2 (2004): 79-85.
4. Lawrence BD., et al. “Adjacent segment disease after anterior cervical discectomy and fusion: a systematic review”. Spine Journal7 (2012): 534-546.
5. Ohara S., et al. “Antero-lateral partial vertebrectomy for ossification of the posterior longitudinal ligament”. Spinal Surgery 8 (1994): 125-130.
6. Hirano Y., et al. “History and evolution of laminoplasty”. Neurosurgical Clinics of North America1 (2018): 107-113.
7. Hakuba A. “Trans-unco-discal approach: A combined anterior and lateral approach to cervical discs”. Journal of Neurosurgery3 (1976): 284-91.
8. George B., et al. “Multisegmental cervical spondylotic myelopathy and radiculopathy treated by multilevel oblique corpectomies without fusion”. Neurosurgery1 (1999): 81-90.
9. Jho HD. “Endoscopic microscopic transpedicular thoracic discectomy. Technical note”. Journal of Neurosurgery 1 (1997): 125-129.
10. Kadoya S. “Grading and scoring system for neurological function in degenerative cervical spine disease—Neurosurgical Cervical Spine Scale—”. Neurologia Medico-Chirurgica1 (1992): 40-41.
11. Saunders RL. “On the pathogenesis of the radiculopathy complicating multilevel corpectomy”. Neurosurgery 3 (1995): 408-412.

Citation

Citation: Keisuke Onoda., et al. “Less Invasive Surgery for Cervical Spine - A Technique of Anterior Oblique Keyhole Approach".Acta Scientific Neurology 8.8 (2025): 17-22.

Copyright

Copyright: © 2025 Keisuke Onoda., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.