An Oblique Approach for Cordotomy or for Cervical Disc Excision
CORDOTOMY or cervical disc excision may be accomplished through the currently standard incision or through a new oblique approach (Fig. 1). This paper discusses the new method, which is believed to be reported for the first time.
The oblique approach is simple and safe. It offers a minimum of surgical trauma to all tissues encountered. Only a small incision is necessary, yet optimum exposure is provided either for cordotomy or for disc excision.
The technic for the oblique approach consists of a small paramedian opening made directly over an interlaminar space, rather than a larger midline incision followed by a subperiosteal dissection and lateral retraction for the same exposure.
The essential steps of the oblique approach follow.
General endotracheal anesthesia is administered, and the patient is positioned, prone or sitting. If disc excision is to be performed, precise localization of the incisional site is necessary, and the first of two lateral cervical roentgenograms is made. For cordotomy, roentgenographic localization is not necessary.
A small paramedian incision is made directly over the desired interspace, from 2 to 5 cm. to the right or left of the midline. The larger the neck, the farther the incision is made from the midline.
The paramedian incision is deepened, in a slightly medial direction, until the laminae and an interspace are reached. All tissues encountered are divided in the same plane. Hemostasis is promptly achieved with a suction-cautery apparatus. (If disc excision is to be performed, a radiopaque marker is inserted . . .