Microendoscopic Cervical Anterior Decompression and Fusion: A Technical Note

Microendoscopic cervical anterior decompression and fusion (MECAF) is a novel minimally invasive surgical technique developed to reduce postoperative complications commonly associated with anterior cervical discectomy and fusion (ACDF), such as airway obstruction, dysphagia, and recurrent laryngeal nerve paralysis, particularly in elderly patients and those with comorbidities. Utilizing an 18-mm tubular retractor and a 25-degree endoscope, MECAF minimizes soft tissue trauma by approaching along the lateral border of the omohyoid muscle, enabling safe en bloc retraction of the trachea and esophagus. Under endoscopic visualization, anterior cervical discectomy, cage insertion, and fixation with a self-locking plate are performed. Between 2021 and 2024, 20 patients (mean age 60.0 ± 15.3 years) underwent MECAF for cervical disc herniation, myelopathy, radiculopathy, or myeloradiculopathy. The procedure was initially applied to single-level cases and subsequently extended to two-level surgeries, yielding favorable outcomes. Notably, there were no instances of postoperative dyspnea, hoarseness, or dysphagia. These findings suggest that MECAF is a safe, effective, and less invasive alternative to conventional ACDF.