ArticleCureus2025
Navigated Minimally Invasive Cervical and Cervicothoracic Fixation: A Technical Note on Surgical Technique and Proposed Classification.
Article in Cureus, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Authors and funding
6 authors.
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No grant is acknowledged in the PubMed record.
Abstract
The purpose of this study is to propose a standardized classification of minimally invasive cervical pedicle screw (MICEPS) fixation according to the levels instrumented and the extent of the construct, thereby facilitating reproducible surgical planning and technique. We developed a three-tiered MICEPS classification with a specific surgical algorithm based on anatomic levels and construct length: Type 1, subaxial cervical fixation; Type 2, subaxial cervical to proximal thoracic fixation; and Type 3, subaxial cervical to T3/4 cervicothoracic stabilization. All techniques employ O-arm intraoperative navigation and preserve posterior tension-band integrity. We describe key technical steps and compare each type in terms of incision strategy, soft-tissue handling, and navigation workflow. Each MICEPS type employs a tailored combination of small paramedian incisions, muscle-sparing dissection, and intraoperative navigation to achieve stable posterior fixation while minimizing soft-tissue trauma: Type 1 is indicated for short subaxial cervical fusions (typically C3-C6/C7). It uses a single small paramedian incision on each side of the spine and follows a purely muscle-sparing corridor. Type 2 extends the construct to T1 or T2, still via one paramedian incision per side, but involves splitting and subsequent re-approximation of the trapezius muscle. Type 3 reaches down to T3/T4, employing two mini-open incisions on each side and controlled splitting of the trapezius. All three techniques provide a safe, anatomically direct corridor without the need for significant retraction that could compromise navigation accuracy. The provided MICEPS classification offers a clear, anatomically driven framework for minimally invasive posterior cervical and cervicothoracic fixation. By tailoring incision number, muscle-sparing corridors, and navigated instrumentation to the required fusion extent, surgeons can achieve high-precision screw placement, minimal morbidity, expedited recovery, and high repeatability. Although a formal learning curve exists, MICEPS represents a safe, cost-effective alternative to open techniques in appropriately selected patients.
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