Comparison of outcomes following minimally invasive and open posterior cervical foraminotomy: description of minimally invasive technique and review of literature.

Although minimally invasive posterior cervical foraminotomy (MIS-PCF) is frequently employed in the treatment of cervical radiculopathy, there are very few studies directly comparing outcomes between MIS-PCF and open posterior cervical foraminotomy and between MIS-PCF and percutaneous endoscopic (full-endoscopic) posterior cervical foraminotomy (FE-PCF). This study includes a description of technique and systematic review of literature and analysis of clinical studies comparing outcomes between MIS-PCF and open posterior cervical foraminotomy and between MIS-PCF and FE-PCF. Six comparative studies, including one randomized controlled trial were included in analysis. Average operative time ranged from 60.5 to 171 minutes in the open group and 77.65 to 115 minutes in the MIS group. Mean intraoperative blood loss ranged from 43.5 to 246 cc in the open group and 42 to 138 cc in the MIS group. Average postoperative length of stay ranged from 58.6 to 304.8 hours in the open group and 20 to 273.6 hours in the MIS group. Two studies reported significantly increased VAS-N (Neck) scores postoperatively in patients undergoing open cervical foraminotomies, however both studies reported that the differences lost statistical significance with longer follow-up. There were no significant differences in complications or reoperations between open and MIS groups. One retrospective cohort study was included in analysis that compared MIS-PCF and FE-PCF. Postoperatively at 24 months, mean NDI and VAS-N were significantly lower after FE-PCF than MIS-PCF. There was no significant change in VAS-A (Arm) between the two groups. Direct comparative studies between MIS-PCF and open cervical foraminotomy are limited in number. Although, there is a significant heterogeneity in studies comparing open and MIS-PCF there appears to be a trend of decreased hospital length of stay and postoperative analgesic usage in the minimally invasive cohort

Evaluation of the Effectiveness of Cervical One-Hole Split Endoscopic Keyhole Surgery for Cervical Radiculopathy

Yunze Feng,1,&ast; Wencan Zhang,1,&ast; Kunpeng Li,1 Xiangyu Lin,1 Chen Liu,1 Chongyi Wang,1 Bingtao Hu,1 Kaibin Wang,1 Wanlong Xu,1 Haipeng Si1,2 1Department of Orthopedics, Qilu Hospital, Shandong University, Jinan, Shandong, 250000, People’s Republic of China; 2Key Laboratory of Qingdao in Medicine and Engineering, Department of Orthopedics, Qilu Hospital (Qingdao), Shandong University, Qingdao, Shandong, 266035, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Haipeng Si, Key Laboratory of Qingdao in Medicine and Engineering, Department of Orthopedics, Qilu Hospital (Qingdao), Shandong Universityl, Qingdao, Shandong, 266035, People’s Republic of China, Email [email protected] Wanlong Xu, Department of Orthopedics Qilu Hospital, Shandong University, Jinan, Shandong, 250000, People’s Republic of China, Email [email protected]: One-hole Split Endoscopy (OSE) is a newer surgical modality that can be applied to posterior cervical foraminotomy (PCF), lumbar discectomy, laminectomy, and decompression. It incorporates intervertebral foraminotomy, open surgery, and other lumboendoscopic techniques with a wide observation field, free space, and compatibility with various spinal surgical techniques and instruments. This study investigated the clinical efficacy of minimally invasive posterior cervical nucleus pulposus removal for cervical spondylotic radiculopathy (CSR) by OSE-Keyhole technique.Patients and Methods: This was a retrospective study of 63 patients treated with OSE keyhole treatment for CSR between May 2021 and September 2023 at Qilu Hospital of Shandong University, Qilu Hospital of Shandong University (Qingdao, China), and Second Hospital of Shandong University, respectively. Clinical outcomes included patients’ preoperative and postoperative visual analogue scale (VAS) - arm and neck, Japanese Orthopaedic Association Assessment Treatment Score (JOA) - cervical spine, which were collected at baseline, two days postoperatively, one month postoperatively, and three months postoperatively after the last follow-up visit for evaluation, and perioperative indicators, including intraoperative bleeding, length of hospital stay, postoperative complications, and reoperations, which were also collected.Results: Statistical analyses were performed for the baseline data and follow-up results of 63 patients. Compared to the preoperative baseline values, the follow-up results two days, one month and three months after surgery showed significant improvements in vas-arm, neck and JOA scores in the operated patients (P< 0.05) as well as a reduction in all perioperative-related indices.Conclusion: In the treatment of cervical pain and disability due to radiculopathy, OSE keyhole removal of the posterior cervical nucleus pulposus is a better clinical option as it is less invasive and recovers better postoperatively.Keywords: nerve root type cervical spondylosis, unilateral cervical disc herniation, posterior cervical laminectomy, single-channel endoscop

Research progress on posterior cervical foraminotomy for the treatment of cervical spondylotic radiculopathy

The incidence of cervical spondylotic radiculopathy is relatively high among cervical spine diseases. Surgical options for its treatment include anterior cervical discectomy and fusion, disc arthroplasty, and posterior cervical foraminotomy. Posterior cervical foraminotomy, which can avoid problems related to fusion and surgical instruments, as well as the complications associated with anterior approaches, has become a popular alternative to anterior cervical surgery and is now considered a simple and effective surgical method for treating cervical spondylotic radiculopathy. With the continuous development of minimally invasive concepts and the innovation of various auxiliary techniques in spinal surgery, the technique is being continuously improved. It has broad prospects for application in the treatment of cervical spondylotic radiculopathy

Comparative Study of Anterior Transvertebral Foraminotomy and Anterior Cervical Discectomy and Fusion for Unilateral Cervical Spondylotic Radiculopathy

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Complications and Management of Endoscopic Spinal Surgery

In the past, the use of endoscopic spine surgery was limited to intervertebral discectomy; however, it has recently become possible to treat various spinal degenerative diseases, such as spinal stenosis and foraminal stenosis, and the treatment range has also expanded from the lumbar spine to the cervical and thoracic regions. However, as endoscopic spine surgery develops and its indications widen, more diverse and advanced surgical techniques are being introduced, and the complications of endoscopic spine surgery are also increasing accordingly. We searched the PubMed/MEDLINE databases to identify articles on endoscopic spinal surgery, and key words were set as “endoscopic spinal surgery,” “endoscopic cervical foramoinotomy,” “PECD,” “percutaneous transforaminal discectomy,” “percutaneous endoscopic interlaminar discectomy,” “PELD,” “PETD,” “PEID,” “YESS” and “TESSYS.” We analyzed the evidence level and classified the prescribed complications according to the literature. Endoscopic lumbar surgery was divided into full endoscopic interlaminar and transforaminal approaches and a unilateral biportal approach. We performed a comprehensive review of available literature on complications of endoscopic spinal surgery. This study particularly focused on the prevention of complications. Regardless of the surgical methods, the most common complications related to endoscopic spinal surgery include dural tears and perioperative hematoma. transient dysesthesia, nerve root injury and recurrence. However, Endoscopic spinal surgery, including full endoscopic transforaminal and interlaminar and unilateral biportal approaches, is a safe and effective a treatment for lumbar as well as cervical and thoracic spinal diseases such as disc herniation, lumbar spinal stenosis, foraminal stenosis and recurrent disc herniation

Single-stage C6-7 ACDF with T1-2 Oblique Keyhole Transcorporeal Disectomy to Treat Cervico-thoracic Tandem Disc Herniation: A Case Report

Symptomatic cervico-thoracic tandem disc herniation occurs very rarely. On the other hand, cervical disc herniations are common and may be treated via a variety of surgical procedures. Symptomatic upper thoracic disc herniations are extremely rare, and use of a surgical approach in their treatment is controversial due to the narrow operative space within which surgical procedures must be performed. We report an extremely rare case of symptomatic tandem C6-7 and T1-2 disc herniation successfully treated via single-stage, single-incision, C6-7 anterior cervical decompression and fusion, and T1-2 oblique keyhole transcorporeal discectomy. This is the first symptomatic cervico-thoracic tandem disc herniation with its treatment

AOSpine Consensus Paper on Nomenclature for Working-Channel Endoscopic Spinal Procedures

Study Design: International consensus paper on a unified nomenclature for full-endoscopic spine surgery. Objectives: Minimally invasive endoscopic spinal procedures have undergone rapid development during the past decade. Evolution of working-channel endoscopes and surgical instruments as well as innovation in surgical techniques have expanded the types of spinal pathology that can be addressed. However, there is in the literature a heterogeneous nomenclature defining approach corridors and procedures, and this lack of common language has hampered communication between endoscopic spine surgeons, patients, hospitals, and insurance providers. Methods: The current report summarizes the nomenclature reported for working-channel endoscopic procedures that address cervical, thoracic, and lumbar spinal pathology. Results: We propose a uniform system that defines the working-channel endoscope (full-endoscopic), approach corridor (anterior, posterior, interlaminar, transforaminal), spinal segment (cervical, thoracic, lumbar), and procedure performed (eg, discectomy, foraminotomy). We suggest the following nomenclature for the most common full-endoscopic procedures: posterior endoscopic cervical foraminotomy (PECF), transforaminal endoscopic thoracic discectomy (TETD), transforaminal endoscopic lumbar discectomy (TELD), transforaminal lumbar foraminotomy (TELF), interlaminar endoscopic lumbar discectomy (IELD), interlaminar endoscopic lateral recess decompression (IE-LRD), and lumbar endoscopic unilateral laminotomy for bilateral decompression (LE-ULBD). Conclusions: We believe that it is critical to delineate a consensus nomenclature to facilitate uniformity of working-channel endoscopic procedures within academic scholarship. This will hopefully facilitate development, standardization of procedures, teaching, and widespread acceptance of full-endoscopic spinal procedures

The Role and Future of Endoscopic Spine Surgery: A Narrative Review

Many types of surgeries are changing from conventional to minimally invasive techniques. Techniques in spine surgery have also changed, with endoscopic spine surgery (ESS) becoming a major surgical technique. Although ESS has advantages such as less soft tissue dissection and normal structure damage, reduced blood loss, less epidural scarring, reduced hospital stay, and earlier functional recovery, it is not possible to replace all spine surgery techniques with ESS. ESS was first used for discectomy in the lumbar spine, but the range of ESS has expanded to cover the entire spine, including the cervical and thoracic spine. With improvements in ESS instruments (optics, endoscope, endoscopic drill and shaver, irrigation pump, and multiportal endoscopic), limitations of ESS have gradually decreased, and it is possible to apply ESS to more spine pathologies. ESS currently incorporates new technologies, such as navigation, augmented and virtual reality, robotics, and 3-dimentional and ultraresolution visualization, to innovate and improve outcomes. In this article, we review the history and current status of ESS, and discuss future goals and possibilities for ESS through comparisons with conventional surgical techniques

Сervical microdiscectomy: method and surgical strategy

Objective. To implement the interlaminar lateral approach for extraction of herniated discs (HD) in the cervical spine.Materials and methods. During 2012–2015 in Regional psychoneurological hospital 56 patients with cervical HD were operated. There were 22 females, 36 males among them. Disc herniation at the CV–CVI level occurred in 21 cases, CVI–CVII in 20 cases. The main disease signs were cervicalgia, monoradiculopathy. Fifty patients with medial hernia were operated using anterior cervical microscopic discectomy approach to HP extraction and intervertebral cage implantation (PEEK material). Six patients with lateral hernia were operated using posterior interlaminar cervical microdiscectomy. Anterior approach was performed by a standard method using CODMAN retractor, high-speed drill Stryker TPS. The posterior interlaminar approach was performed using paramedian incision 3 cm, intermuscular approach to the posterior lateral mass and arch on the affected side with Medtronic Metrix system followed by interlaminectomy performed by high-speed drill not more than 1 cm that was rather enough for hernia extraction from under nerve root.Results. In all cases we managed to achieve the regression of radicular and cervicalgia syndromes. No complications were fixed during both surgical approaches. There was no difference observed in duration of surgical intervention using both methods, which was about (64±12) min. All patients were verticalized and activated in 3–4 hours after surgery.Conclusion. Cervical microdiscectomy is a standard method for cervical HD surgery. The posterior interlaminar approach is an effective method used for lateral herniations, especially sequestered ones. It promotes the preservation of intervertebral disc and reduction of the total cost of surgery due to no necessity to use the implants-prosthesis. We suppose the posterior cervical microdiscectomy of lateral, sequestered intervertebral disc herniations in cervical spine to become a standard method of treatment