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.

Keywords: TESSYS; cervical; endoscopic discectomy; radiculopathy; thoracic; transforaminal.

Figure 1

Posterior cervical unilateral laminectomy and bilateral decompression. (A) Preoperative T2-weighted sagittal magnetic resonance image demonstrates severe spinal cord stenosis from C3-6 and cord myelomalacia. (B) Lateral fluoroscopic image depicts the cannulated beveled tubular retractor with the Delta working-channel endoscope and Shrill drill at the spinolaminar junction of C3-4. (C) Endoscopic camera view of the bilaterally decompressed thecal sac. (D) Postoperative T2-weighted sagittal magnetic resonance image demonstrating the resolution of the cervical stenosis after the C3-6 endoscopic laminectomy.

Figure 2

Posterior cervical foraminotomy. (A) Preoperative T2 axial magnetic resonance image illustrating right C5-6 foraminal stenosis. (B) Lateral fluoroscopic view demonstrating the position of the beveled tubular retractor on the laminar-facet junction at C5-6. (C) Endoscopic camera views of the laminar-facet junction and the Shrill drill removing the superior lateral edge of the C6 lamina and (D) the decompressed C6 nerve root.

Figure 3

Anterior cervical discectomy. (A) Preoperative T2 magnetic resonance image showing foraminal disc herniation at C5-6 on the left side. (B) Lateral fluoroscopic image demonstrating the tubular retractor in the disc space. (C) Postoperative T2 sagittal magnetic resonance image showing complete decompression.

Figure 4

Anterior transcorporal discectomy. (A) Preoperative T2 sagittal and (B) axial magnetic resonance images of a C5-6 herniated disc. (C) Lateral fluoroscopic image of the TESSYS endoscope and tubular retractor placed through the body of C5.

Figure 5

Posterior thoracic unilateral laminectomy and bilateral decompression. (A) Sagittal and (B) axial T2-weighted magnetic resonance images of a T9-10 disc herniation and severe canal stenosis and increased cord signal. (C) Lateral and (D) anteroposterior fluoroscopic images of the tubular retractor, working-channel endoscope with 10-mm outer diameter, and endoscopic drill used for the laminectomy procedure. (E) Intraoperative endoscopic image showing decompressed thecal sac after drilling.

Figure 6

Transforaminal thoracic endoscopic discectomy and foraminotomy. (A) Sagittal and (B) axial T2-weighted magnetic resonance image demonstrating a T9-10 central disc extrusion and cord compression. (C) Intraoperative lateral and (D) anteroposterior fluoroscopic images demonstrating the placement of the beveled tubular retractor, endoscope, and high-speed drill; the drill is removing the ventral portion of the superior articular process. (E) Intraoperative endoscopic image demonstrating drilling of the ventral portion of the superior articular process (foraminoplasty), taken at the same time as 6C and 6D. (F) Intraoperative endoscopic image of the thecal sac after drilling of the superior articular process. (G) Postoperative T2-weighted sagittal and (H) axial magnetic resonance images of the decompressed spinal cord.