European Spine Journal (2018) 27:1454–1459
IDEAS AND TECHNICAL INNOVATIONS
A technical case report on use of tubular retractors for anterior
cervical spine surgery
Arvind G. Kulkarni
· Ankit Patel
· N. V. Ankith
Received: 20 July 2017 / Revised: 23 October 2017 / Accepted: 9 December 2017 / Published online: 19 December 2017
© Springer-Verlag GmbH Germany, part of Springer Nature 2017
Purpose The authors put-forth this technical report to establish the feasibility of performing an anterior cervical corpectomy
and fusion (ACCF) and a two-level anterior cervical discectomy and fusion (ACDF) using a minimally invasive approach
with tubular retractors.
Methods First case: cervical spondylotic myelopathy secondary to a large postero-inferiorly migrated disc treated with
corpectomy and reconstruction with a mesh cage and locking plate. Second case: cervical disc herniation with radiculopathy
treated with a two-level ACDF. Both cases were operated with minimally invasive approach with tubular retractor using a
single incision. Technical aspects and clinical outcomes have been reported.
Results No intra or post-operative complications were encountered. Intra-operative blood loss was negligible. The patients
had a cosmetic scar on healing. Standard procedure of placement of tubular retractors is suﬃcient for adequate surgical
exposure with minimal invasiveness.
Conclusion Minimally invasive approach to anterior cervical spine with tubular retractors is feasible. This is the ﬁrst report
on use of minimally invasive approach for ACCF and two-level ACDF.
Keywords Tubular retractors · Cervical spine · Minimal invasive spine surgery · Anterior cervical discectomy and fusion ·
Anterior approach to the cervical spine is used to treat
numerous cervical disorders including degenerative [1,
2], traumatic, oncological, inﬂammatory, congenital [2–4]
vascular, and infective etiologies . Cervical spondylotic
myelopathy (CSM) is a common cause of neurologic mor-
bidity and can substantially decrease the quality of life .
Anterior cervical discectomy and fusion (ACDF) as well
as anterior cervical corpectomy and fusion (ACCF) have
become well-accepted surgical procedures for symptomatic
cervical myelopathy. These are described as safe and suf-
ﬁcient procedures with excellent fusion rates [5–7]. Despite
these procedures being highly successful, complications
such as dysphagia, hematoma-formation, recurrent laryngeal
nerve palsy and oesophageal perforation have been reported
[8, 9]. In anterior cervical surgery, pre-vertebral muscle dis-
section for adequate visualization can induce neck discom-
fort, which can result in a slower recovery . Minimally
invasive spine surgery aims at faster recovery, which allows
patients to resume their normal activities as soon as possible.
Tubular retractor systems such as the METRx and MAST
QUADRANT system (Medtronic SofamorDanek) have been
extensively utilized to pursue and accomplish the goals of
surgery with minimal access in posterior-based MIS proce-
dures of the lumbar, thoracic and the cervical spine.
There is limited literature on the use of minimal access
tubular retractors to decompress and reconstruct the ante-
rior cervical spine [11–13]. Here, we report two cases in
which the tubular retractor system was used in anterior
cervical surgery. Unlike the previous published literature
* Arvind G. Kulkarni
N. V. Ankith
Department of Orthopedics and Spine Surgery, Mumbai
Spine Scoliosis and Disc Replacement Center, Bombay
Hospital and Medical Research Center, Room No-206,
Marine Lines, Mumbai 400002, India