Abstract: Objective　To summarize the surgical procedures and complications of a modified Far-lateral approach for treatment of upper cervical spinal canal lesions. 　Methods　The clinical data of 18 patients with upper cervical spinal canal lesions treated by modified Far-lateral approach were retrospectively analyzed from January 2016 to October 2018 in our hospital.   Results　As seen in the approach, the visual field was clear and comprehensive, which could fully reveal the ventral lesions of the cranial-cervical junction and upper cervical spinal cord, and also fully reveal the communicating tumors of vertebral canal. All tumors were completely resected under the microscope. The approach inflicted less damage to the bone. In all patients in the group, the posterior median tension band of the corresponding segmental vertebral body was retained. During the process of closing the vertebral canal, the incision muscle was sutured to the corresponding attachment. This approach had mild impact on the static and dynamic stability of the spine. No internal fixation of spine was done to the patients. Two cases of subcutaneous effusion occurred after operations. There were no cases of operative death or intracranial infection. At the last follow-up, 18 patients recovered well (Karnofsky scores were above 80) without occurrence of adverse prognosis and cervical instability.  Conclusion　The modified Far-lateral approach for the treatment of upper cervical spinal canal lesions has a good visual field exposure with low incidence of surgery-related complications. According to the current follow-up, the approach causes little damage to cervical stability. 

Key words:  , Upper cervical spinal canal lesions, 　Modified Far-lateral approach, 　Ventral lesions of spinal cord , Cervical stability