Posterior endoscopic cervical foramiotomy and discectomy: clinical and radiological computer tomography evaluation on the bony effect of decompression with 2 years follow-up

Abstract

Purpose Cervical radiculopathy is a common disabling cervical spine condition. Open anterior and posterior approaches are the conventional surgical treatment approaches with good clinical outcomes. However, the soft tissue damage in these procedures can lead to increase perioperative morbidity. Endoscopic spine surgery provides more soft tissue preservation than conventional approaches. We investigate the radiological and clinical outcomes of posterior endoscopic cervical foraminotomy and discectomy. Methods A prospective clinical and radiological study with retrospective evaluation were done for 25 patients with 29 levels of cervical radiculopathy who underwent posterior endoscopic cervical discectomy from November 2016 to December 2018. Clinical outcomes of Visual Analogue Scale, Neck Disability Index and MacNab’s score were evaluated at pre-operative, post-operative 1 week, 3 months and final follow-up. Preoperative and post-operative final follow-up flexion and extension roentgenogram were evaluated for cervical stability assessment. Pre-operative and post-operative computer tomography cervical spine evaluation of foraminal length in ventro-dorsal, cephalad-caudal dimensions, sagittal foraminal area and using 3D CT reconstruction coronal decompression area were done. Results Twenty-nine levels of cervical radiculopathy underwent posterior endoscopic cervical decompression. The mean follow-up was 29.6 months, and the most common levels affected were C5/6 and C6/7. There was a complication rate of 12% with 2 cases of neurapraxia and one case of recurrent of prolapsed disc. There was no revision surgery in our series. There was significant clinical improvement in Visual Analogue Scale and Neck Disability Index. Prospective comparative study between preoperative and final follow-up mean improvement in VAS score was 5.08 ± 1.75, and NDI was 45.1 ± 13.3. Ninety-two percent of the patients achieved good and excellent results as per MacNab’s criteria. Retrospective evaluation of the radiological data showed significant increments of foraminal dimensions: (1) sagittal area increased 21.4 ± 11.2 mm2, (2) CT Cranio Caudal length increased 1.21 ± 1.30 mm and (3) CT ventro-dorsal length increased 2.09 ± 1.35 mm and (4) 3D CT scan reconstruction coronal decompression area increased 536 ± 176 mm2, p < 0.05. Conclusion Uniportal posterior endoscopic cervical foraminotomy and discectomy are safe, efficient and precise choreographed set of technique in the treatment of cervical radiculopathy. It significantly improved clinical outcomes and achieved the objective of increasing in the cervical foramen size in our cohort of patients.

Comparative Analysis of the Biomechanical Characteristics After Different Minimally Invasive Surgeries for Cervical Spondylopathy: A Finite Element Analysis

“…Full-endoscopic cervical discectomy is generally divided into two types, i.e., anterior transdiscal approach of endoscopic cervical discectomy (ATd-ECD) and posterior endoscopic cervical foraminotomy (PECF) ( Yang et al, 2014 ; Ren et al, 2020 ). PECF is an indirect decompression of the technique through the posterior approach, which requires the removal of the partial bony structure and soft tissue with a radius of 3–4 mm around the V-point (inferior margin of the cephalic lamina, superior margin of the caudal lamina, and the medial border of facet joints [FJ]) to decompress the nerve root ( Kim et al, 2015 ; Ahn, 2016 ; Won et al, 2017 ; Wu P. H. et al, 2021 ). The ATd-ECD technique can achieve precision and direction of approach using contrast agents, but a tunnel needs to be built in the intervertebral disc; after that, the endoscopic instruments remove the protruded disc through the intervertebral space ( Lee and Lee, 2014 ; Quillo-Olvera et al, 2018 ; Haijun et al, 2021 ).…”

Rationale of Endoscopic Spine Surgery: A New Paradigm Shift In Spine Surgery From Patient’s benefits to Public Interest In This New Era of Pandemic

“…There is increase in the benefit zone in endoscopic spine surgery to include more complex spinal procedures evolving from discectomy and decompression to fusion procedures 1,3,17) . Posterior and anterior cervical decompression procedures have produced comparable good results with gold standard anterior cervical discectomy and fusion in some of the series published 9,14,20,21) . Expansion of indication to spinal cord level degenerative pathologies in cervical and thoracic spine had led to potential decrease in perioperative morbidities of these high risk surgeries 12,13,18) .…”

Overview of Tips in Overcoming Learning Curve in Uniportal and Biportal Endoscopic Spine Surgery

“…Surgeries at cervical and thoracic region has added risk as these are cord level surgeries. Spinal cord is intolerant of any sort of manipulation and retraction 55,57) . This is confounded further by the presence of important vascular structures such as vertebral artery in the foramen transversarium and aorta and segmental arteries in thoracic spine.…”