Komaitis Spyridon, Zygogiannis Konstantinos, Karatzoglou Sotirios, Klitsinikos Dimitrios, Pasku Dritan, Salem Khalid
Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, United Kingdom.
Centre for Spinal Studies and Surgery, Queen's Medical Centre, Nottingham University Hospitals, NHS Trust, Nottingham, GBR.
Cureus. 2025 Sep 1;17(9):e91414. doi: 10.7759/cureus.91414. eCollection 2025 Sep.
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.
本研究的目的是根据固定节段和内固定范围，提出一种微创颈椎椎弓根螺钉（MICEPS）固定的标准化分类方法，从而促进可重复的手术规划和技术应用。我们基于解剖节段和内固定长度，开发了一种具有特定手术算法的三级MICEPS分类：1型，下颈椎固定；2型，下颈椎至胸近端固定；3型，下颈椎至T3/4颈胸段稳定。所有技术均采用O型臂术中导航，并保留后张力带的完整性。我们描述了关键技术步骤，并在切口策略、软组织处理和导航工作流程方面对每种类型进行了比较。每种MICEPS类型都采用了小的旁正中切口、保留肌肉的解剖和术中导航的定制组合，以实现稳定的后路固定，同时将软组织创伤降至最低：1型适用于下颈椎短节段融合（通常为C3 - C6/C7）。它在脊柱两侧各使用一个小的旁正中切口，并遵循纯粹的保留肌肉通道。2型将内固定范围扩展至T1或T2，仍然是每侧一个旁正中切口，但涉及斜方肌的劈开和随后的重新缝合。3型延伸至T3/T4，每侧采用两个迷你开放切口，并对斜方肌进行可控劈开。所有这三种技术都提供了一条安全、解剖学上直接的通道，无需进行可能影响导航准确性的大量牵拉。所提供的MICEPS分类为微创颈椎后路和颈胸段固定提供了一个清晰的、基于解剖学的框架。通过根据所需融合范围调整切口数量、保留肌肉通道和导航器械，外科医生可以实现高精度的螺钉置入、最小的发病率、加快恢复和高重复性。尽管存在正式的学习曲线，但在适当选择的患者中，MICEPS是开放技术的一种安全、经济有效的替代方法。
