Spinous Process Osteotomy for Exposure of the Posterior Cervical Spine: An Innovative Technique to Preserve Midline Structures

BACKGROUND: Surgery on the posterior cervical spine involves bilateral exposure and removal of midline structures, which may lead to chronic neck pain, dropped head syndrome, and an ugly scar. We present our experience of an innovative technique of posterior cervical approach using spinous process osteotomy with preservation of midline structures. METHODS: A total of 25 consecutive myelopathic patients underwent 1- to 4-level posterior cervical decompression with or without fusion and were followed up prospectively for 6 to 24 months. Left-sided exposure was done through a midline skin incision, and bilateral exposure of the spine was achieved through spinous process osteotomy. Laminectomy with or without instrumented fusion was performed, and the wound was closed over a drain. All patients were mobilized without orthoses. RESULTS: There were 15 men and 10 women with a mean age of 68 years; mean blood loss was 150 mL; mean operating time was 150 minutes; mean follow-up was 12 months. The mean improvement in Neck Disability Index at final follow-up was 26% with a 2-point improvement in visual analog scale. Japanese Orthopaedic Association score improved from a mean of 12 to 16, and using Odom's criteria, the final outcome was good in 19 patients and excellent in 6. Nurick grade improved from 3 to 1, and all patients reported significant relief of myelopathic symptoms without chronic neck pain. Two patients had postoperative superficial wound infections, and 1 patient underwent reoperation for hematoma. CONCLUSION: In this cohort study, the spinous process osteotomy technique was easy to perform, was safe with a low complication rate, and had positive outcomes. However, more studies are required to compare its efficacy with other techniques.