Many patients with cervical spondylosis who need surgical treatment ask me, “Is cervical spine surgery safe?” “Can I do a minimally invasive surgery?” These two questions are very well posed and very representative, and they are the two most important concerns of all patients. It is true that cervical spine surgery is operated around the spinal nerves, and at first glance it is indeed risky. However, the history of cervical spine surgery has been around for decades and in China for more than 30 years, and the volume of surgery has been increasing, but the riskiness of the surgery has been decreasing and the complication rate is very small, so how do we try to ensure the safety and minimally invasive nature of cervical spine surgery? We know that the pathological changes of cervical spondylosis are a common disease based on degenerative changes of cervical discs, secondary to pathological changes of cervical disc herniation, osteophytes and ligamentous hyperplasia, which stimulate or compress the adjacent nerves and blood vessels and cause corresponding clinical symptoms, while in fact, the pathological state of each cervical spondylosis patient is not the same. For example, some people simply have a herniated disc in one segment, while others have multi-segmental herniation, some have ossification of the posterior longitudinal ligament and ossification of the ligamentum flavum, while some have combined cervical spinal canal developmental stenosis. Even if it is a simple herniated disc, due to the different directions of herniation, some patients have spinal cord compression, while others just have nerve root compression. The development of the surgical plan needs to be individualized, and one technique and surgical approach alone cannot be suitable for all patients. The goal of surgery for cervical spondylosis is to remove the degenerated tissue that compresses the spinal nerves and blood vessels, and then to reconstruct the sequence of the cervical vertebrae, and only when this surgical goal is achieved does the surgery have long-term effects. So can the current so-called minimally invasive cervical spine surgery achieve this surgical goal? The current minimally invasive surgical modalities for the cervical spine are radiofrequency ablation and percutaneous endoscopic surgery. Cervical disc ablation technology is only suitable for patients with cervical disc bulge and mild cervical disc herniation due to limited energy; cervical percutaneous endoscopic anterior surgery is very risky and cannot be carried out universally at home and abroad, and cannot be performed for cervical spine sequence reconstruction, while cervical percutaneous endoscopic posterior surgery is only suitable for patients with simple postero-lateral herniation compressing nerve roots, with very narrow indications, and cannot be performed for cervical spine Sequence reconstruction is not possible. In summary, the current minimally invasive cervical spine techniques are not very safe and effective. There is another basic principle in the development of cervical spine surgery plan, which is to release the spinal nerve compression from which direction it comes, so there are posterior and anterior cervical spine surgeries. Posterior cervical surgery: This is surgery performed from the back of the neck and is suitable for people with multisegmental cervical spondylosis, spinal stenosis or ossification of the posterior longitudinal ligament. The posterior approach achieves indirect decompression by removing all or part of the posterior lamina, which is less risky than the anterior approach, simpler to expose, and more effective for patients whose cervical spine has its own physiological curvature. Posterior single-opening vertebroplasty and other procedures can preserve the mobility of the cervical intervertebral spine, and the incidence of posterior convexity deformity and adjacent segmental degeneration is smaller, and has been widely adopted. Anterior cervical surgery: as the name implies, the surgery is performed in front of the neck. At present, most anterior cervical surgeries are minimally invasive, with small surgical incisions and quick postoperative recovery. The surgery mainly removes the protruding and deformed disc, and for those with osteophytes, also removes the osteophytes and the hooked vertebral joints on both sides to avoid residual possible compressive materials. A variety of reconstructions are performed after removal of normal structures, mostly using plates and fusion devices to reconstruct the height and stability of the cervical spine. In recent years, artificial disc replacements have also emerged, which can preserve intersegmental motion in the cervical spine and have excellent clinical outcomes for the right patient. How do you make anterior cervical spine surgery minimally invasive? The answer is to make excellent condition judgments and surgical planning for the patient, to try to deal only with the disc that is causing the symptoms, and to affect as few other discs and vertebrae as possible while ensuring that clinical results are achieved. Small and scarless incisions for anterior cervical spine surgery The anterior cervical spine single gap surgery area is small and deep, and sometimes difficult to see with the naked eye when doing decompression of a narrow individual gap. How do you try to ensure the safety of the surgery? I use a German Zeiss advanced spine surgery microscope to probe into the surgical area from a different viewpoint, clearly distinguish the discs and ligaments that are compressing the nerves as well as the adjacent nerves and blood vessels that need to be protected, and accurately remove the diseased tissue. Clear field for anterior cervical spine surgery under the microscope During surgical decompression, small blood vessels that are invisible to the naked eye bleed, but can be seen clearly under the microscope, so I can use very low-power bipolar electrocoagulation to stop the bleeding precisely without worrying about damaging the spinal nerves. Therefore, another very outstanding advantage of microsurgery is the low bleeding. Another very important tool is the high-speed abrasive drill, which can quickly and safely remove the bones that are compressed on the surface of the spinal nerve, without aggravating the nerve compression during the decompression process.