Introduction: There is a steep learning curve for a successful posterior endoscopic cervical foraminotomy and discectomy (PECFD), an important surgery for cervical foraminal or lateral disc herniation, and cervical radiculopathy due to a small operation field. PECFD becomes even more challenging in patients who have prominent shoulders and/or short necks with C6–7-disc herniation, because of the difficulty to localize C6–7 vertebral structure under fluoroscopy.
The study objective is to prove that the PECFD can be performed safely and successfully to C6–7-disc herniation on patients with prominent shoulders and/or short necks following our novel surgical techniques under fluoroscopic guidance.
Materials and Methods: PECFD was performed on a patient who had an extruded foraminal disc herniation at C6–7 on the left with left arm pain and weakness. Due to his prominent shoulders and a short neck, the C6–7 anatomic site was not visible under traditional anterior-posterior (AP) and lateral fluoroscopic views. The authors inserted a reference needle to C4–5 facets between C4 and C5 pedicles under AP and lateral fluoroscopic views. Following the reference needle, the C6–7 facets were easily located with an oblique fluoroscopic view. A large endoscopic cannula was used initially for adequate resection of C6–7 facets, followed by a small cannula for nerve root handling with minimal pressure and discectomy.
Results: The novel surgical techniques resulted in a complete resection of the C6–7-disc herniation and resolution of the patient’s radiculopathy with no postoperative complications.
Conclusion: PECFD can be safely and successfully applied for C6–7-disc herniation in patients with prominent shoulders and/or short necks using our novel surgical techniques.
Background: Surgical treatment for lumbar degenerative spondylolisthesis has been shown to provide better longterm outcomes than conservative treatment. However, there is variation in surgical approaches employed by surgeons. This study investigates current surgical practice patterns and compares perioperative outcomes of 3 common surgical treatments for this pathology.Methods: A survey was administered to surgeons who attended the Lumbar Spine Research Society (LSRS) meeting in 2014. Data were extracted from the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) from 2005 to 2014 to characterize the same responses. The 2 data sets were compared. Perioperative outcomes of those in the ACS-NSQIP posterior fusion subcohorts were characterized and compared.Results: Posterior surgical approaches utilized by surgeons who responded to the LSRS survey were similar to those captured by ACS-NSQIP where 72% of those with degenerative spondylolisthesis were fused. Of those that were fused, 8% had an uninstrumented posterior fusion, 33% had an instrumented posterior fusion, and 59% had an instrumented posterior fusion with interbody. On multivariate analysis, there was no difference in risk of postoperative adverse events, readmission, or length of stay between these 3 common types of fusion.Conclusions: Practice patterns for the posterior management of lumbar degenerative spondylolisthesis were similar between LSRS survey responses and ACS-NSQIP data. The ACS-NSQIP perioperative outcome measures assessed were similar regardless of surgical technique. These findings highlight that cost-benefit considerations and longer-term outcomes have to be the measures by which surgical technique is chosen for degenerative spondylolisthesis.
Lumbar Spine
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