A new minimally invasive posterior approach for the treatment of cervical radiculopathy and myelopathy: surgical technique and preliminary results

Boehm, Heinrich; Greiner-Perth, R.; Elsaghir, Hesham; Allam, Yasser

doi:10.1007/s00586-002-0522-7

Cited by 36 publications

(16 citation statements)

References 22 publications

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“…Recently, an increasing amount of emphasis has been placed on minimally invasive spine surgery (MISS), including the use of micro-endoscope, minimal incision, and muscle preservation techniques [1,11,16]. Because it is difficult to apply intraoperative US to confirm the decompression of the spinal cord during MISS, the only clue to predict the decompression status would be the surface appearance of the dura mater.…”

Section: Discussionmentioning

confidence: 99%

Ultrasonographic quantification of spinal cord and dural pulsations during cervical laminoplasty in patients with compressive myelopathy

et al. 2012

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Purpose Pulsatile movements of the dura mater have been interpreted as a sign that the cord is free within the subarachnoid space, with no extrinsic compression. However, the association between restoration of pulsation and adequate decompression of the spinal cord has not been established. The present study investigated the relationship between the extent of spinal cord decompression and spinal cord and dural pulsations based on quantitative analysis of intraoperative ultrasonography (US). Methods Eighty-five consecutive patients (55 males, 30 females; mean age, 64 ± 13 years) who underwent cervical double-door laminoplasty to relieve compressive myelopathy were enrolled. Spinal cord decompression status was classified as: Type 1 (non-contact), the subarachnoid space was retained on the ventral side of the cord, Type 2 (contact and apart), the cord showed both contact with and separation from the anterior element of the cervical spine, or Type 3 (contact), the cord showed continuous contact with the anterior element of the cervical spine. Spinal cord and dura mater dynamics were quantitatively analyzed using automatic video-tracking software. Furthermore, the intensity of spinal and dural pulsation was compared with the recovery of motor function at 1 year after surgery as measured by increase in the Japanese Orthopaedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). Results Spinal cord pulsation amplitude ranged from 0.01 to 0.84 mm (mean 0.30 ± 0.16 mm) and dural pulsation amplitude ranged from 0.01 to 0.38 mm (mean 0.14 ± 0.08 mm). Average spinal cord pulsation amplitude in Type 2 patients was significantly larger than that in the other groups, whereas, average dural pulsation amplitudes were similar for all three groups. There was a significant correlation between spinal cord and dural pulsation amplitudes in Type 1 patients, but not in Type 2 or Type 3 patients. Type 3 patients showed a particularly poor correlation between spinal cord and dural pulsations. Spinal cord pulsation amplitude was moderately correlated with the recovery of motor function evaluated by JOACMEQ. Conclusion The present results suggest that restoration of dural pulsation is not an adequate indicator of sufficient decompression of the spinal cord following a surgical procedure.

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Section: Discussionmentioning

confidence: 99%

Ultrasonographic quantification of spinal cord and dural pulsations during cervical laminoplasty in patients with compressive myelopathy

et al. 2012

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“…There has been a resurgence of interest in posterior foraminotomy, especially with recent popularization of minimally invasive surgery (MIS) techniques using tubular access. 1,6,7,11 The 2 concerns with posterior foraminotomies are same-level degeneration/kyphosis secondary to partial resection of the facet joint and persistent neck and shoulder pain secondary to muscle stripping with the open procedure. In vitro studies have shown that segmental hypermobility of the cervical spine results if a foraminotomy involves resection of more than 50% of the facet.…”

Section: Division Of Neurosurgery and Spinal Program Krembil Neuroscmentioning

confidence: 99%

Posterior cervical foraminotomy for the treatment of cervical radiculopathy

Fehlings¹,

Gray²

2009

SPI

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“…They are mostly series of endoscopic procedures, [12][13][14][15]20 with only very few reports of minimally invasive microscopic posterior cervical decompression. 21,22 Although the endoscopic technique remains fascinating, it might be demanding and require additional training for the "nonendoscopic" surgeon. However, virtually every surgeon is familiar and comfortable today using the operating microscope; therefore, the technique described in this article might be more easily reproducible.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Microscopic Posterior Cervical Decompression: Simple, Safe, and Effective

Vergara

2017

J Neurol Surg A Cent Eur Neurosurg

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Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly population. Surgery is usually successful in preventing any deterioration, as well as improving functional status and quality of life. This study assesses the safety and efficacy of minimally invasive microscopic posterior cervical decompression for the treatment of CSM. A retrospective review of patients with myelopathy from cervical stenosis treated with minimally invasive posterior cervical decompression was performed. The operation was performed through a nonexpandable tubular retractor and operating microscope. Twelve patients were identified. There were no early or late complications. Average age was 74.5 years. Three patients were > 80 years of age and tolerated the operation extremely well. Three cases were two-level decompressions; nine were single level. Eight patients were operated on as elective cases, with average postoperative length of stay of 0.9 days. Average surgical time was 77.5 minutes per level. Postoperative neck pain was minimal (1.5/10). All patients improved postoperatively, particularly those who started with severe deficits. In fact, five patients were unable to walk preoperatively and were wheelchair- or bed-bound, and they returned to walking within weeks. The modified Japanese Orthopedic Association score improved from 8.4 (range: 4-14) to 13.5 (range: 10-15); the Nurick score changed from 3.8 (range: 2-5) to 2.3 (range: 1-4). Minimally invasive microscopic posterior cervical decompression is a safe and effective treatment for CSM in selected cases. Our initial experience highlights the potential benefits of this relatively new technique.

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A new minimally invasive posterior approach for the treatment of cervical radiculopathy and myelopathy: surgical technique and preliminary results

Cited by 36 publications

References 22 publications

Ultrasonographic quantification of spinal cord and dural pulsations during cervical laminoplasty in patients with compressive myelopathy

Ultrasonographic quantification of spinal cord and dural pulsations during cervical laminoplasty in patients with compressive myelopathy

Posterior cervical foraminotomy for the treatment of cervical radiculopathy

Minimally Invasive Microscopic Posterior Cervical Decompression: Simple, Safe, and Effective

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