Less invasive anterior fusion of the cervical spine

Summary Trauma, degenerative and inflammatory diseases, or tumours may destabilise and deform the cervical spine, causing compression of the spinal cord and/or the nerve roots. The goals of surgical therapy are decompression of the neurostructures and restoration of the physiological alignment, along with stabilisation by fusion and fixation of the affected vertebrae. 'Minimally invasive' defines an effective surgical treatment with the least morbidity for the patient. The combined use of computed tomography (CT) and MRI, microsurgical techniques, intra-operative fluoroscopy and devices for internal fixation (plates and screws) has significantly improved the outcome. Nowadays bone graft substitutes, endoscopy and image-guided navigation are being introduced for clinical use, in order to reduce the surgical morbidity even further. Benefits of this evolution are: surgical procedures tailored for different pathologies; early mobilisation and rehabilitation, especially of elderly patients. Disadvantages are: a rapidly increasing number of operative procedures with a demanding learning curve, which have to be performed at specially qualified centres; and increasing sophistication (as a potential source of error) of the surgical equipment. A more balanced cooperation between industry and clinicians, along with an ethical agreement on how much surgery should be done, has become mandatory.