Article
Endoscopic posterior decompression for cervical myelopathy
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Authors
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Y. Nishimura
- Spinal Surgery Centre, Department of Neurosurgery, KOYO Hospital, Wakayama, Japan
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K. Kubo
- Spinal Surgery Centre, Department of Neurosurgery, KOYO Hospital, Wakayama, Japan
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N. Nakao
- Department of Neurosurgery, Wakayama Medical University, Wakayama, Japan
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T. Luebbers
- Spinal Surgery Centre, Department of Neurosurgery, KOYO Hospital, Wakayama, Japan
| Published: | June 4, 2012 |
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Outline
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Objective: In our department, spinal endoscopic posterior decompression has long been performed as a minimally invasive spinal surgery for lumbar lesions, but it has been determined that our operators surpassed the learning curve for spinal endoscopic procedures, which was considered to be relatively high, and have thus become highly skilled in performing these procedures, and so the indications for spinal endoscopic procedures have been extended to include cervical lesions. In this study, with regard to surgeries using this surgical technique, we examined the surgical results and herein introduce this surgical technique and report on the particular precautions that are required.
Methods: Since 2001, endoscopic surgery has been performed at the lumbar level, and since 2007, the indications have been extended to include the cervical level. We examined 91 cases (52 males, 39 females; average age: 61.7 years old) that underwent this surgery before October 2011. The diseases comprised 70 cases of cervical spinal canal stenosis, 18cases of cervical disc herniation, and 3 cases of ossification of the posterior longitudinal ligament. The neurological symptoms were compared based on the Japan orthopaedic association (JOA) scores before and after surgery. We examined surgery time, amount of bleeding, usage of analgesics after surgery, and serum CRP and CPK levels, and we compared some of these values with the corresponding values for conventional laminoplasty. We also examined the postoperative deformation of the primary curvature with plain X-rays.
Results: The average JOA scores were 10.9 ± 3.9 before surgery and 15.1 ± 2.1 after surgery. The average surgery time was 2 hours and 14 minutes, the average amount of bleeding was 24.2 cc, the average CRP level was 1.22, and the average CPK level was 149.3. There were no cases involving postoperative deformation of the primary curvature, nor were there complications such as C5 paralysis, etc. In addition, there were no cases that required shifting to microsurgery during surgery.
Conclusions: This surgical technique was able to almost completely preserve the posterior support elements and it was also useful due to its significantly minimal invasiveness. However, it is believed that this surgical technique requires sufficient training and careful approaches until it is mastered.
