Minimally invasive spine surgery: an animal model for endoscopic approach to the anterior cervical and upper thoracic spine

BACKGROUND: Minimally invasive video-assisted techniques are currently used for thoracic and lumbar spine surgery with the aim of reducing the morbidity. Recently, an endoscopic approach has been used for endocrine neck surgery, with reduced pain and improved cosmetic results. PURPOSE: To develop an animal model for an endoscopic neck approach to the anterior cervical and upper thoracic spine. METHODS: Five pigs were used. A combination of one 5- and two 3-mm laparoscopic instruments was used to dissect the spine, and dedicated instrumentation was then used to perform discectomies. Carbon dioxide was insufflated at 10 mm Hg. Dissection was carried out upward and downward on the anterior aspect of the spine; discectomy was performed at various levels and evaluated at autopsy. RESULTS: All pigs tolerated the procedure well. Visibility of the cervical spine was excellent, and exposure from C1 to T3 was obtained. For discectomy, an additional 10-mm trocar was inserted, and discectomy of C3-C4 and C4-C5 was performed. Proper location and adequacy were confirmed at autopsy. CONCLUSION: The endoscopic neck approach allows exposure of the entire cervical spine and the upper thoracic spine in the porcine model. This approach has the potential to reduce the morbidity associated with the open cervical approach and provides a wider view and exposure than conventional open surgery. The availability of the porcine model allows the acquisition of the necessary technical skills before introducing this advanced procedure in humans.