Endoscopic Spine Surgery of the Cervicothoracic Spine: A Review of Current Applications

Abstract

Background: Endoscopic spine surgery in the cervicothoracic spine is generating continued interest in a rapidly evolving field. The authors present 4 techniques for fully endoscopic cervical spine surgery: (1) posterior cervical unilateral laminectomy and bilateral decompression, (2) posterior cervical foraminotomy, (3) anterior cervical discectomy, and (4) anterior transcorporal discectomy. Two techniques for fully endoscopic thoracic spine surgery are also presented: (1) posterior thoracic unilateral laminectomy and bilateral decompression and (2) transforaminal thoracic endoscopic discectomy and foraminotomy.Methods: We describe 6 different surgical approaches and review the relevant literature about each technique.Results: The clinical application of endoscopic spine surgery techniques has evolved over the past 40 years. Recent data suggest comparable outcomes to other procedures and perhaps fewer complications and quicker recovery when these techniques are used in the cervical and thoracic spine. Significant variability exists in these approaches depending on the goal of canal decompression, root decompression, and the site of the pathology.Conclusions: Each endoscopic approach in the cervicothoracic spine has its technical nuances, outcomes, advantages, and disadvantages, making fully endoscopic cervicothoracic spine surgery an exciting and growing field.

Full Endoscopic Surgery for Thoracic Pathology: Next Step after Mastering Lumbar and Cervical Endoscopic Spine Surgery?

“…Thoracic disc herniation and stenosis are relatively rare, and various symptoms make them difficult to diagnose. Due to the complexity of neural and vascular structure, surgical treatment of degenerative thoracic pathology is challenging [ 3 , 14 , 20 – 23 ]. Transforaminal approach offers the advantages of unique access to the spinal canal with minimal trauma of the anatomical structures, which make it superior to other surgical approaches for treating patients with chronic pain.…”

“…Alternative foraminoplasty techniques are (1) drilling the ventral aspect of the superior facet using a high-speed drill (Joimax® Shrill, 3.5 mm diamond burr) under direct endoscopic visualization and (2) using a Jamshidi needle to pass through the superior articular facet to reach at the midpedicular level on AP fluoroscopic view. A guidewire was inserted through the needle followed by serial dilation with side cutting bone drill inserted over the wire [ 3 , 8 , 14 , 15 ] ( Figure 3 ).…”