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Posterior cervical fusion with facet cages could be a good alternative to ACDF in several cases with very good outcomes. A great cooperation with Dr Daniel Iglesias Aparicio from the Instituto Aragones de Traumatologia in Zaragoza, Spain.
Although percutaneous DTRAX is a very safe process, in the opinion of Dr. Iglesias doing it endoscopically provides:
- a more precise localization and a double safety control (radioscopic and endoscopic) in the choice of the implant site with maximum control in the initial landing of the instruments, minimizing the risk of going medial (severe neurological complication) or lateral,
- control with vision during the entire facet preparation and during the implantation of the cage,
- a precise estimation of the orientation of the facet transversely with respect to a cervical axial section to avoid violation of the facet in that plane since it cannot be controlled with radiological scopy (we would need a navigator), since the plane is not always exactly neutral since more proximal facets C3-C4 are usually more posteromedial and the more caudal ones are more posterolateral C6-C7
- the choice of eliminating possible obstacles such as osteophytes at the facet entry,
- the possibility of associating a foraminotomy and root decompression increasing the foramen in anteroposterior since the cage widens it in craniocaudal.