Tissue-sparing posterior cervical fusion. A, Midline minimally invasive incision at C7-T1 with superior two-level access. Posteroanterior view shows guide tube over decortication rasp. Facets are decorticated with medial-to-lateral angulation, avoiding medial nerve. Intraoperative anteroposterior (B) and lateral (C) fluoroscopy images showing facet chisel properly positioned in C5-6 facet. On lateral view, radiolucent hole is at posterior facet border. D, Lateral cervical view with decortication trephine over access chisel to decorticate superior and inferior lateral masses at C5-6. E, Lateral cervical view of guide tube at lower level C5-6 with access to several superior levels through one minimally invasive incision.(From McCormack BM, Dhawan R: Novel instrumentation and technique for tissue sparing posterior cervical fusion, J Clin Neurosci 34:299, 2016.) SEE TECHNIQUE 38.7.