Clinical outcomes of microendoscopic decompression surgery for cervical myelopathy

Abstract

Retrospective study on the results of microendoscopic decompression surgery for the treatment of cervical myelopathy. The purpose of this study was to describe the microendoscopic laminoplasty (MEL) technique as the surgical method in the treatment of cervical myelopathy, and to document the clinical outcomes for MEL surgery. Endoscopic surgery poses several challenges for the aspiring endoscopic surgeons, the most critical of which is mastering hand-eye coordination. With training in live animal and cadaver surgery, the technical progress has reduced the problem of morbidity following surgery. The authors have performed microendoscopic decompression surgery on more than 2,000 patients for lumbar spinal canal stenosis. Fifty-one patients underwent the posterior decompression surgery using microendoscopy for cervical myelopathy at authors' institute. The average age was 62.9 years. The criteria for exclusion were cervical myelopathy with tumor, trauma, severe ossification of posterior longitudinal ligament, rheumatoid arthritis, pyogenic spondylitises, destructive spondylo-arthropathies, and other combined spinal lesions. The items evaluated were neurological evaluation, recovery rates; these were calculated following examination using the Hirabayashi's method with the criteria proposed by the Japanese Orthopaedic Association scoring system (JOA score). The mean followup period was 20.3 months. The average of JOA score was 10.1 points at the initial examination and 13.6 points at the final follow-up. The average recovery rate was 52.5%. The recovery rate according to surgical levels was, respectively, 56.5% in one level, 46.3% in two levels and 54.1% in more than three levels. The complications were as follows: one patient sustained a pin-hole-like dura mater injury inflicted by a high-speed air-drill during surgery, one patient developed an epidural hematoma 3 days after surgery, and two patients had the C5 nerve root palsy after surgery. The epidural hematoma was removed by the microendoscopy. All two C5 palsy improved with conservative therapy, such as a neck collar. These four patients on complications have returned to work at the final follow-up. This observation suggests that the clinical outcomes of microendoscopic surgery for cervical myelopathy were excellent or showed good results. This minimally invasive technique would be helpful in choosing a surgical method for cervical myelopathy.

Percutaneous endoscopic cervical laminectomy

“…[12][13][14][15] However, the technique does have some disadvantages and requires a drill to be used in a surgical field of approximate 1 cm 3 and resection of the yellow ligaments is performed via this small bone window. Therefore, this operation takes a lot of time and causes some operator fatigue.…”

Full-endoscopic cervical arcocristectomy for the treatment of spinal stenosis: results of a cadaver study

“…Nonetheless, the disadvantage of extended surgical approach remains. To avoid the invasiveness of the above-mentioned approach different tubular or complete endoscopic procedures to the cervical spine have been introduced [3,12,15,19]. Cervical disc disease is the leading indication for endoscopic foraminotomy according to literature.…”

“…Cervical disc disease is the leading indication for endoscopic foraminotomy according to literature. Microendoscopic decompression for cervical myelopathy has only been reported in a few cases, however with good or excellent results [12,19]. In the published cases, a tubular retractor system with an inserted endoscope was used.…”

“…In the published cases, a tubular retractor system with an inserted endoscope was used. The diameters of the tubes were between 16 and 20 mm [12,14,19]. The purpose of the current study was to show the technical feasibility of a full-endoscopic approach with more flexibility in combination with the above-described arcocristectomy in order to combine the advantages of both procedures.…”

“…To avoid this large tissue trauma, minimally invasive procedures are currently used for one to three level laminectomy and foraminotomy in patients and cadaver studies [12,14,19]. We assume that minimally invasive approaches for extensive cervical stenosis with decompression on multiple levels including protection of stability of the posterior column can reduce narrowing of spinal cord and avoid kyphotic deformity with the need of posterior fusion procedure.…”