Full endoscopic cervical spine surgery

Abstract

Background: The authors present 4 techniques for fully-endoscopic cervical spine surgery with accompanying case series: (I) posterior cervical unilateral laminectomy and bilateral decompression, (II) posterior cervical foraminotomy (PCF), (III) anterior cervical discectomy, and (IV) anterior transcorporeal discectomy.

Methods: We retrospectively reviewed fully endoscopic cervical spine surgery cases at one high-volume endoscopic center in the United States and present clinical data extracted from endoscopic spine surgery performed over a 6-year period with a minimum clinical follow up of 1 year.

Results: A series of 114 patients who underwent fully endoscopic cervical spine surgery between 2012 and 2018 is presented. Clinical results and technical data are presented.

Conclusions: Fully endoscopic cervical spine surgery is an emerging surgical technique for addressing cervical radiculopathy and myelopathy through a minimally invasive approach.

Keywords: Endoscopic spine surgery; cervical radiculopathy; minimally-invasive; myelopathy.

Figure 1

Posterior cervical unilateral laminectomy and bilateral decompression. (A) Pre-operative T2-weighted sagittal MRI demonstrates severe spinal cord stenosis from C3–6 and cord myelomalacia; (B) lateral and (C) AP fluoroscopic images depicting the cannulated beveled tubular retractor with the Delta^® working channel endoscope and Shrill^® at the spinolaminar junction of C3–4; (D) post-operative T2 weighted sagittal MR image demonstrating the resolution of the cervical stenosis after the C3–6 endoscopic laminectomy; (E) endoscopic cameral view at the C3–4 spinolaminar junction. The C3 and C4 lamina, facet, and ligamentum flavum are demonstrated; (F) endoscopic camera view of the Shrill^® drill performing the laminectomy; (G) endoscopic camera view of the Kerrison rongeur removing the contralateral ligamentum flavum; (H) endoscopic camera view of the bilaterally decompressed thecal sac. AP, anterior-posterior.

Figure 2

PCF. (A) Preoperative T2 axial MRI illustrating the right C5–6 foraminal stenosis; (B) lateral and (C) AP fluoroscopic views demonstrating the position of the beveled tubular retractor on the laminar-facet junction at C5–6; (D,E) endoscopic camera views of (D) the laminar-facet junction at C5–6, (E) the Shrill^® drill removing the superior lateral edge of the C6 lamina, and (F) the decompressed C6 nerve root. PCF, posterior cervical foraminotomy; AP, anterior-posterior.

Figure 3

Anterior cervical discectomy. (A) Preoperative T2 sagittal and (B) T2 axial MR images demonstrating the C4–5 herniated disc superior to a previous C5-6 fusion; (C) lateral and (D) AP fluoroscopic images of the CESSYS^® Cervical Hybrid endoscope and working channel in the C4–5-disc space; (E,F,G,H) endoscopic camera views of (E) the C4–5-disc herniation, (F) the endoscopic grasper removing the herniation, (G) the Shrill^® drill drilling down the uncinate joint, and (H) the bendable grasper removing disc from the foramen. AP, anterior-posterior; PLL, posterior longitudinal ligament.

Figure 4

Anterior transcorporeal discectomy. (A) Preoperative T2 sagittal and (B) axial MR images of a C5–6 herniated disc; (C) lateral fluoroscopic image of the TESSYS® endoscope and tubular retractor placed through the body of C5; (D) endoscopic image of the disc herniation; (E) endoscopic image of the decompressed thecal sac after removal of the disc herniation. AP, anterior-posterior.