General Session: Endoscopic Surgery
Presented by: J. Du - View Audio/Video Presentation (Members Only)
X. Zhang(1), Z. Huang(1), J. Du(1)
(1) General Hospital of Chinese PLA, Spine, Beijing, China
Background: Posterior percutaneous spine endoscopy has been successfully applied to treat the cervical spondylotic radiculopathy. Treatment of cervical spinal stenosis with posterior percutaneous endoscopic approach for partial laminectomy has not been reported.
Objective: To assess the early clinical outcome, surgical techniques and postoperative complications of percutaneous full-endoscopic cervical partial laminectomy in treating cervical spinal stenosis.
Materials and Methods: 4 cases of cervical spinal stenosis admitted in our hospital between October 2015 and January 2016 underwent percutaneous full-endoscopic cervical partial laminectomy under local anaesthesia. All patients have cervical disc herniation and hypertrophic ligamentum flavum. 3 patients underwent a single segmental decompression and one underwent three segments decompression. Para-midline incision at the lesion side was made, and decompression was performed at the lower edge of the upper lamina, upper edge of the lower lamina under endoscopy. Limited recessive decompression was performed at the bottom of spinous process and contralateral lamina, followed by resection of ligamentum flavum. Japanese Orthopaedic Association (JOA) score was used to assess the spinal cord function and VSA pain score was used to assess the axial neck pain.
Results: All 4 patients underwent percutaneous full-endoscopic cervical partial laminectomy under local anaesthesia. The average age of patients was 62.5 ± 14.7 years. Duration of the follow-up was 7.75 ± 1.5 months. The average JOA score was elevated from 10.25 ± 2.2 preoperatively to 15.5 ± 1.3 at the latest follow-up , with recovery rate of 30.9 ± 8.8%. VSA pain score of all patients was 0 at the latest follow-up . There were no complications including dural sac tear and C5 nerve root palsy.
Conclusion: This study reported satisfactory results and this technique had several advantages. (1) Unilateral approach and bilateral decompression with sufficient decompression range. (2) It is more minimally invasive compared to traditional partial laminectomy and could reduce the incidence of postoperative axial neck pain and kyphosis. (3) Local anesthesia facilitates intraoperative monitoring. Despite that long-term results are still needed, the short-term results indicate that the percutaneous full-endoscopic cervical partial laminectomy is a sufficient and safe supplement and alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.
Keywords: cervical spinal stenosis, spine endoscopy, lamina decompression