HOW I DO IT - SPINE DEGENERATIVE Minimally invasive anterior cervical discectomy and fusion: a valid alternative to open techniques Pierluigi Vergara 1 & Ivan Timofeev 1 Received: 22 August 2018 /Accepted: 27 October 2018 # Springer-Verlag GmbH Austria, part of Springer Nature 2018 Abstract Background Anterior cervical discectomy and fusion (ACDF) is a well-standardized treatment for cervical myelopathy/ radiculopathy. The aim of this study is to assess the feasibility of minimally invasive ACDF. Method Retrospective review of six patients who underwent minimally invasive ACDF using microscope and tubular retractors. Clinical and radiological outcomes and surgical complications were reviewed. Conclusion Minimally invasive microscopic ACDF through tubular retractors is a feasible option and therefore an alternative to conventional open procedures. However, it does require advanced technical skills and good understanding of the MIS principles and limitations of the technique. Keywords ADCF . Anterior cervical discectomy and fusion . Minimally invasive . MIS . Tubular retractor Relevant surgical anatomy Anterior cervical discectomy and fusion (ACDF) was first described in the late 1950s [2, 6] and has since become the one of the most popular treatments for cer- vical disc prolapses and cervical stenosis. More recently, due to the rising interest towards minimally invasive surgery (MIS), the approach has been adapted for less invasive or minimally invasive techniques [ 1, 3–5, 7–10]. Nevertheless, no series of microscopic MIS- ACDF have been published so far. In the present series, we have adapted the standard ACDF approach for the use of tubular retractors. Anterior neck anat- omy and anterior cervical approaches are well known to spinal surgeons. Essential anatomy to be familiar with: – SCM and carotid sheath laterally – Trachea and esophagus medially – Recurrent laryngeal nerve – Longus colli and uncovertebral joints, essential to main- tain the midline during the discectomy – Vertebral artery and anatomy of roots Description of the technique Six patients were treated with microscopic MIS-ACDF by a single surgeon, who already had an extensive experience with MIS prior to this series. All patients were appropriately consented and underwent general anesthesia. A standard supine position was used, with the neck slightly extended. The operative level was identified with lateral fluorosco- py. The approach can be obviously performed from either side but we prefer a right-sided approach in most cases, as we find it easier for a right-handed surgeon. A right-sided 2-cm horizontal incision medial to the medial edge of the sternocleidomastoid muscle was used. In order to avoid injuries to the esophagus or vascular structures by inserting the sequential dilators percutaneously (reported This article is part of the Topical Collection on Spine degenerative Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00701-018-3719-1) contains supplementary material, which is available to authorized users. * Pierluigi Vergara spinalneuro@gmail.com 1 Department of Neurosurgery, Addenbrooke’s Hospital, Cambridge University Hospital, Box 166, Hills Road, Cambridge CB20QQ, UK Acta Neurochirurgica https://doi.org/10.1007/s00701-018-3719-1