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      Posterior Endoscopic Cervical Decompression: Review and Technical Note

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          Abstract

          Endoscopic spine surgery for the treatment of degenerative spinal diseases from lumbar to cervical spine has accelerated over the past 2 decades. Posterior endoscopic cervical discectomy (PECD) has been described as a safe, effective, and minimally invasive procedure for cervical radiculopathy or even part of the myelopathy. This procedure also has been validated with comparable outcomes to open and microscopic surgery. Radiculopathy due to foraminal disc herniation or foraminal stenosis should be the optimum indications of this procedure. Intraoperative 3-dimensional navigation can help surgeons to get quick and great quality guidance for endoscopic surgeons. In this review, we will focus on the technical details and evidence-based results of PECD which is a promising procedure for cervical radiculopathy with the advantages of a minimally invasive method.

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          Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study.

          Sebastian Ruetten, Georgios Godolias, Martin Komp … (2008)
          Prospective, randomized, controlled study of patients with lateral cervical disc herniations, operated either in a full-endoscopic posterior or conventional microsurgical anterior technique. Comparison of results of cervical discectomies in full-endoscopic posterior foraminotomy technique with the conventional microsurgical anterior decompression and fusion. Anterior cervical decompression and fusion is the standard procedure for operation of cervical disc herniations with radicular arm pain. Mobility-preserving posterior foraminotomy is the most common alternative in the case of lateral localization of the pathology. Despite good clinical results, problems may arise due to traumatization of the access. Endoscopic techniques are considered standard in many areas, since they may offer advantages in surgical technique and rehabilitation. These days, all disc herniations of the lumbar spine can be operated in full-endoscopic technique. With the full-endoscopic posterior cervical foraminotomy a procedures is available for cervical disc operations. One hundred and seventy-five patients with full-endoscopic posterior or microsurgical anterior cervical discectomy underwent follow-up for 2 years. In addition to general and specific parameters, the following measuring instruments were used: VAS, German version North American Spine Society Instrument, Hilibrand Criteria. After surgery 87.4% of the patients no longer had arm pain, and 9.2% had occasional pain. The clinical results were the same in both groups. There were no significant difference between the groups in the revision or complication rate. The full-endoscopic technique brought advantages in operation technique, preserving mobility, rehabilitation, and traumatization. The recorded results show that the full-endoscopic posterior foraminotomy is a sufficient and safe supplement and alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.
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            Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience.

            Richard Fessler, T. Khoo (2002)
            We have previously reported the feasibility of using the microendoscopic foraminotomy (MEF) technique in a cadaveric study. We now report our initial clinical experience with this novel technique. From March 1998 to January 2001, we prospectively used the MEF technique in 25 patients with cervical root compression from either foraminal stenosis or disc herniation. The patients' demographic, clinical presentation, surgical, and outcome data were recorded. Another 26 patients treated via open cervical laminoforaminotomy were used for comparison. MEF cases involved less blood loss (138 versus 246 ml per level). MEF patients recovered more rapidly, had a shorter postoperative stay (20 versus 68 hours), and needed fewer narcotics (11 versus 40 equivalents). There were two durotomies after MEF. Overall, our initial experience with the MEF procedure yielded symptomatic improvement for approximately 87 to 92% of patients, depending on which symptom was analyzed. After MEF (mean follow-up, 16 mo; minimum follow-up, 1 year), patients with radiculopathy experienced resolution of their symptoms in 54%, improvement in 38%, and no change in 8% of cases. For open surgery, radiculopathy resolved in 48%, improved in 40%, and remained unchanged in 12%. For neck pain, the MEF results were 40% resolved, 47% improved, and 13% unchanged. Open results for neck pain were 33% resolved, 56% improved, and 11% unchanged. Overall, there was no significant difference in outcomes between the groups. The MEF technique yielded clinical results equivalent to those of the open surgical group as well as to those described in the literature. MEF patients, however, had less blood loss, shorter hospitalizations, and a much lower postoperative pain medication requirement.
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              Cervical stability after foraminotomy. A biomechanical in vitro analysis.

              T Zdeblick, Bradford E Warden, D. Zou … (1991)
              Laminectomy or facetectomy of the cervical spine, or both, may be needed for decompression of the spinal cord or of the nerve-roots. Acute stability of the cervical spine was tested after laminectomy and progressive staged foraminotomies in an in vitro model. Twelve cervical spines from human cadavera were used in the experiment. Biomechanical testing included the application of an axial load, the application of a flexion and extension moment, and the application of a torsional moment. Each specimen was tested intact, after laminectomy of the fifth cervical vertebra, and after progressive foraminotomy of the sixth cervical root. Foraminotomy was performed by resection of 25, 50, 75, and 100 per cent of the facet joint and capsule. Torsional stiffness decreased dramatically when more than 50 per cent of the facet had been resected. Statistically equivalent subsets were the intact specimen, laminectomy, 25 per cent facetectomy, and 50 per cent facetectomy in one subset, and 75 and 100 per cent facetectomy in the least-stiff subset. Flexion-moment testing showed that the posterior strain did not differ among three groups: the intact specimens, those that had been treated with laminectomy, and those that had been treated with a 25 per cent facetectomy. The 50 per cent facetectomy resulted in a 2.5 per cent increase in posterior strain, and the 75 or 100 per cent facetectomy, in a 25 per cent increase in posterior strain compared with the intact specimen. Segmental hypermobility of the cervical spine results if a foraminotomy involves resection of more than 50 per cent of the facet.(ABSTRACT TRUNCATED AT 250 WORDS)
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                Author and article information

                Journal
                Journal ID (nlm-ta): Neurospine
                Journal ID (iso-abbrev): Neurospine
                Journal ID (publisher-id): NS
                Title: Neurospine
                Publisher: Korean Spinal Neurosurgery Society
                ISSN (Print): 2586-6583
                ISSN (Electronic): 2586-6591
                Publication date (Print): July 2020
                Publication date (Electronic): 31 July 2020
                Volume: 17
                Issue: Suppl 1
                Pages: S74-S80
                Affiliations
                Department of Orthopedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chongqing, China
                Author notes
                Corresponding Author Yue Zhou https://orcid.org/0000-0001-7102-6484 Department of Orthopedics, The Second Affiliated Xinqiao Hospital of Army Medical University, Chong Qing 400037, China E-mail: happyzhou@ 123456vip.163.com
                [*]

                Chao Zhang and Junlong Wu contributed equally to this study as co-first authors.

                Author information
                http://orcid.org/0000-0001-7102-6484
                Article
                Publisher ID: ns-2040166-083
                DOI: 10.14245/ns.2040166.083
                PMC ID: 7410369
                PubMed ID: 32746520
                SO-VID: cc75f8e4-4fc7-4b57-8191-85895f390800
                Copyright © Copyright © 2020 by the Korean Spinal Neurosurgery Society
                License:

                This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 March 2020
                Date revision received : 2 May 2020
                Date accepted : 4 May 2020
                Categories
                Subject: Review and Technical Note

                Keywords: minimally invasive spine,posterior endoscopic cervical discectomy,foraminotomy,navigation
                Data availability:
                Keywords: minimally invasive spine, posterior endoscopic cervical discectomy, foraminotomy, navigation

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