Transcorporeal decompression using a fully-endoscopic anterior cervical approach to treat cervical spondylotic myelopathy: surgical design and clinical application

Abstract

Background Anterior cervical discectomy and fusion (ACDF) is a common procedure for treating cervical spondylotic myelopathy (CSM), however, ACDF may cause pseudoarthrosis, accelerated degeneration of adjacent segments, loss of activity of fused segments and other complications. The full-endoscopic technique can treat CSM, without the aforementioned complications above. Therefore, it is of great clinical value to investigate the surgical scheme of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC). Methods A total of 28 cases with single-segment Cervical spondylotic myelopathy (CSM) from April 2017 to July 2019 were involved in this study. The size of the disc-osteophyte complex was measured using imaging data prior to the operation. The diameter and direction of the bony passage was determined according to the size and central position of the complex, respectively. Twenty-eight patients underwent the above scheme for CSM. The clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores. The imaging assessment included MRI, CT and X-rays. Results The diameter of the designed bony passage was about 6.9 mm, and directed toward the lower edge of the diseased lower vertebral body oblique to the center of the disc-osteophyte complex. All patients successfully completed the operation. The postoperative neck pain VAS and JOA were significantly improved compared to preoperative values (p < 0.01). Postoperative MRI indicated complete decompression of the spinal cord. CT scanning 1 year after the operation revealed an almost healed bony passage and X-ray imaging showed satisfactory physiological curvature of the cervical spine, without cervical instability. Conclusion Based on the diameter and direction of the bony passage, as determined by the size and position of the disc-osteophyte complex, indicated by MRI and CT scanning, anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord offers good decompression of the spinal cord and ensures excellent therapeutic outcome.

Anterior transcorporeal approach combined with posterior translaminar approach in percutaneous endoscopic cervical discectomy for two-segment cervical disc herniation treatment: a technical report and early follow-up

“…Although the transdiscal approach is effective for herniation decompression in the disc plane, due to obstruction of the vertebral body, the transdiscal approach is not effective in posterior free herniation of the vertebral body. The transcorporeal approach allows the bone channel to be constructed according to preoperative imaging data, and the decompression plane can be flexibly adjusted between the vertebral and disc planes [ 27 – 29 ]. Furthermore, low intervertebral spaces, calcified discs, and large bones in the intervertebral space will prevent the operation of the transdiscal approach [ 30 ].…”

Anatomical and epidemiological examination of the structure and localization of osteophytes of cervical vertebrae in geriatric patients by using computed tomography method

“…In a study in which anterior cervical osteophytes were treated surgically, the mean length of resected osteophytes was reported as 14.2 mm, and the longest osteophyte was reported to be in the C3-4 vertebral space (Kolz et al, 2021). In a study in which anterior cervical approach was applied in the treatment of cervical myelopathy, the mean length of osteophytes seen in patients was reported as 8.14 mm (Ma et al, 2022). In our study, when osteophytes were evaluated in terms of length, relatively longer (mm) osteophytes were found in males when compared with females.…”

“…Osteophytes are examined in 2 groups as spinal (vertebral) and extraspinal. Cervical vertebral osteophytes cause dysphagia, vocal cord paralysis, peristalsis disorders due to its close proximity to the larynx, pharynx, and oesophagus (Klaassen et al, 2011;Ma et al, 2022). Various anthropological, etiological and epidemiological studies have been conducted on osteophytes in the vertebral column (Chiba et al, 2022;Ezra, Hershkovitz, Salame, Alperovitch-Najenson, & Slon, 2019;Ezra, Kedar, Salame, Alperovitch-Najenson, & Hershkovitz, 2022;Kaçar et al, 2016;Praneatpolgrang, Prasitwattanaseree, & Mahakkanukrauh, 2019;Stanley et al, 2008;Suwanlikhid, Prasitwattanaseree, Palee, & Mahakkanukrauh, 2018;Watanabe & Terazawa, 2006).…”

Correction: Transcorporeal decompression using a fully-endoscopic anterior cervical approach to treat cervical spondylotic myelopathy: surgical design and clinical application

“…Following publication of the original article [ 1 ], the authors corrected the sentence “Table 2 summarises the Cobb angle during the follow-up period” to “Table 3 summarises the Cobb angle during the follow-up period” in the Results and analysis section.…”

“…Correction: Transcorporeal decompression using a fully-endoscopic anterior cervical approach to treat cervical spondylotic myelopathy: surgical design and clinical application Following publication of the original article [1], the authors corrected the sentence "Table 2 summarises the Cobb angle during the follow-up period" to "Table 3 summarises the Cobb angle during the follow-up period" in the Results and analysis section.…”