Posterolateral trans dentate approach to anterior extensive extramedullary tumor of the cervical spine in a pediatric case: how I do it.

BACKGROUND Extramedullary anterior cervical canal tumors can be challenging lesions to reach. The posterolateral trans dentate approach offers an alternative route. METHOD Classic posterior laminoplasty is done to expose the medulla; the dentate ligament is identified as a fibrous structure running from the lateral pial surface of the medulla to the lateral dura between nerve roots spaces. Once the ligament is cut, the medulla can be gently rotated to access the anterior cervical canal. Intraoperative neurophysiological stimulation is mandatory. CONCLUSION This approach allows a safe route, without the need for corpectomies. It should be considered especially in children where multilevel corpectomies could be challenging.