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DOI: 10.1055/s-0034-1373663
Cervical Microendoscopic Interlaminar Decompression through a Midline Approach in Patients with Cervical Myelopathy: A Technical Note
Publication History
19 August 2013
16 January 2014
Publication Date:
12 May 2014 (online)
Abstract
Introduction Microendoscopic techniques through a unilateral paramedian approach or muscle-preserving techniques using a microscope have been reported as minimally invasive spinal decompression procedures for the cervical spine. In this study, we developed a novel technique, cervical microendoscopic interlaminar decompression (CMID) through a midline approach, for treating cervical compression myelopathy.
Methods A total of 29 consecutive patients with single- or two-level cervical compression myelopathy were reviewed. For the single-level cases (e.g., C5–C6), a midline skin incision, ∼ 2 cm in length, was made at the spinal level to be decompressed (C5–C6) under fluoroscopic guidance. The nuchal ligament was longitudinally cut, and tips of the spinous processes (C5 and C6) were exposed. A 16-mm tubular retractor was inserted between the tips of the C5 and C6 spinous processes. A dome-like laminectomy of C5, partial laminectomy of the upper part of C6, and flavectomy were performed. For the two-level cases (e.g., C4–C5 and C5–C6), the decompression procedure was completed by splitting the spinous process (C5). Pre- and postoperative neurologic status was evaluated using the Japanese Orthopedic Association (JOA) score. Neck and arm pain was also evaluated using a numerical rating scale (NRS).
Results Overall, 10 patients underwent single-level decompression, and 19 patients underwent two-level decompression. The average age was 67 years (range: 40–83 years), and the mean follow-up period was 11 months (range: 4–14 months). The average pre- and postoperative JOA scores were 10.2 and 13.5, with a mean recovery rate of 49%. The mean preoperative and postoperative NRS scores were 3.5 and 1.5 for neck pain and 4.6 and 2.9 for arm pain, respectively. One patient showed transient mild weakness of the leg that recovered neurologically within a few weeks. No other postoperative complications were observed.
Conclusion This procedure revealed good short-term surgical results. This technique has advantages including (1) a symmetrical orientation of the surgical field, (2) an intermuscular incision that minimizes blood loss and muscle trauma, and (3) the ability to safely complete the decompression procedure without retracting the cervical spinal cord compared with the unilateral approach. Although long-term surgical results are required, this technique is not only safe but also minimally invasive as a treatment for cervical compression myelopathy.
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References
- 1 Seichi A, Takeshita K, Ohishi I , et al. Long-term results of double-door laminoplasty for cervical stenotic myelopathy. Spine 2001; 26 (5) 479-487
- 2 Chiba K, Ogawa Y, Ishii K , et al. Long-term results of expansive open-door laminoplasty for cervical myelopathy—average 14-year follow-up study. Spine 2006; 31 (26) 2998-3005
- 3 Hosono N, Yonenobu K, Ono K. Neck and shoulder pain after laminoplasty. A noticeable complication. Spine 1996; 21 (17) 1969-1973
- 4 Shiraishi T, Kato M, Yato Y , et al. New techniques for exposure of posterior cervical spine through intermuscular planes and their surgical application. Spine (Phila Pa 1976) 2012; 37: E286-E296
- 5 Shiraishi T. A new technique for exposure of the cervical spine laminae. Technical note. J Neurosurg 2002; 96 (1) (Suppl): 122-126
- 6 Shiraishi T. Skip laminectomy—a new treatment for cervical spondylotic myelopathy, preserving bilateral muscular attachments to the spinous processes: a preliminary report. Spine J 2002; 2 (2) 108-115
- 7 Yabuki S, Kikuchi S. Endoscopic partial laminectomy for cervical myelopathy. J Neurosurg Spine 2005; 2 (2) 170-174
- 8 Minamide A, Yoshida M, Yamada H , et al. Clinical outcomes of microendoscopic decompression surgery for cervical myelopathy. Eur Spine J 2010; 19 (3) 487-493
- 9 Foley KT, Smith MM, Rampersaud YR. Microendoscopic approach to far-lateral lumbar disc herniation. Neurosurg Focus 1999; 7 (5) e5
- 10 Perez-Cruet MJ, Foley KT, Isaacs RE , et al. Microendoscopic lumbar discectomy: technical note. Neurosurgery 2002; 51 (5) (Suppl): S129-S136
- 11 Khoo LT, Fessler RG. Microendoscopic decompressive laminotomy for the treatment of lumbar stenosis. Neurosurgery 2002; 51 (5, Suppl): S146-S154
- 12 Ikuta K, Arima J, Tanaka T , et al. Short-term results of microendoscopic posterior decompression for lumbar spinal stenosis. Technical note. J Neurosurg Spine 2005; 2 (5) 624-633
- 13 Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery 2002; 51 (5, Suppl): S37-S45
- 14 Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg 2001; 95 (1, Suppl): 51-57
- 15 Coric D, Adamson T. Minimally invasive cervical microendoscopic laminoforaminotomy. Neurosurg Focus 2008; 25 (2) E2
- 16 Dahdaleh NS, Wong AP, Smith ZA, Wong RH, Lam SK, Fessler RG. Microendoscopic decompression for cervical spondylotic myelopathy. Neurosurg Focus 2013; 35 (1) E8
- 17 Yabuki S, Konno S, Otani K , et al. Endoscopic surgery for degenerative cervical spine diseases. J Spine Res 2010; 1: 501
- 18 Wiggins GC, Shaffrey CI. Dorsal surgery for myelopathy and myeloradiculopathy. Neurosurgery 2007; 60 (1) (Suppl. 01) S71-S81
- 19 McAllister BD, Rebholz BJ, Wang JC. Is posterior fusion necessary with laminectomy in the cervical spine?. Surg Neurol Int 2012; 3 (Suppl. 03) S225-S231