Microendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy

Restricted access

Object. Cervical radiculopathy caused by either soft herniated disc material or foraminal stenosis is a common problem. Anterior and posterior surgical approaches are commonly used to decompress the nerve root. The authors undertook a study to establish the feasibility of performing a microendoscopic posterior approach for cervical foraminotomy in the clinical setting.

Methods. The authors performed an endoscopic posterior foraminotomy technique in which they used a rigid endoscope, in both a cadaver model and in three clinical cases, including one in which a multiple-level procedure was undertaken. Postoperatively, all patients returned to functional work status within 4 weeks. The mean length of hospitalization was 1.3 days.

Conclusions. The advantages to this technique include improved intraoperative visualization, a smaller incision, and significantly less postoperative discomfort compared with a traditional keyhole approach.

Article Information

Address reprint requests to: Timothy G. Burke, MD., Department of Neurosurgery, The George Washington University, ACC 7–420, 2150 Pennsylvania Ave., N.W., Washington, D.C. 20037. email: timburke@gwu.edu.

© AANS, except where prohibited by US copyright law.

Headings

Figures

  • View in gallery

    Intraoperative photographs. Upper Left: The initial facetectomy is performed with a Kerrison rongeur (KR). The superior (SF) and inferior facets (IF) can be seen. Upper Right: The endoscopic drill is used to unroof the foramen and complete the facetectomy. Center Left: The foraminotomy has been completed. A microdissector (MD) is used to retract the nerve root (NR). A fragment of disc material is clearly seen (large arrow) beneath a suction tip (S). Center Right: The fragment of disc material (D), adjacent to a suction tip, is removed by a pituitary rongeur. The adjacent nerve root can be seen. Lower: The decompressed nerve root is seen following foraminotomy and removal of a fragment of disc material.

References

1.

Davis RA: A long-term outcome study of 170 surgically treated patients with compressive cervical radiculopathy. Spine 46:5235331996Davis RA: A long-term outcome study of 170 surgically treated patients with compressive cervical radiculopathy. Spine 46:523–533 1996

2.

Ebraheim NAXu RBhatti RAet al: The projection of the cervical disc and uncinate process on the posterior aspect of the cervical spine. Surg Neurol 51:3633671999Ebraheim NA Xu R Bhatti RA et al: The projection of the cervical disc and uncinate process on the posterior aspect of the cervical spine. Surg Neurol 51:363–367 1999

3.

Henderson CMHennessy RGShuey HM Jret al: Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery 13:5045121983Henderson CM Hennessy RG Shuey HM Jr et al: Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery 13:504–512 1983

4.

Murphy FSimmons JCBrunson B: Surgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939–1972. J Neurosurg 38:6796831973Murphy F Simmons JC Brunson B: Surgical treatment of laterally ruptured cervical disc. Review of 648 cases 1939–1972. J Neurosurg 38:679–683 1973

5.

Roh SWKim DHCardoso ACet al: Endoscopic foraminotomy using a microendoscopic discectomy system in cadaveric speciemens. Neurosurg Focus 4(2):Article 21998Roh SW Kim DH Cardoso AC et al: Endoscopic foraminotomy using a microendoscopic discectomy system in cadaveric speciemens. Neurosurg Focus 4 (2):Article 2 1998

6.

Scoville WBDohrmann GJCorkill G: Late results of cervical disc surgery. J Neurosurg 45:2032101976Scoville WB Dohrmann GJ Corkill G: Late results of cervical disc surgery. J Neurosurg 45:203–210 1976

7.

WilliamsRW: Microcervical foraminotomy. A surgical alternative for intractable radicular pain. Spine 8:7087161983Williams RW: Microcervical foraminotomy. A surgical alternative for intractable radicular pain. Spine 8:708–716 1983

8.

Woertgen CHolzschuh MRothoerl RDet al: Prognostic factors of posterior cervical disc surgery. A prospective, consecutive study of 54 patients. Neurosurgery 40:7247291997Woertgen C Holzschuh M Rothoerl RD et al: Prognostic factors of posterior cervical disc surgery. A prospective consecutive study of 54 patients. Neurosurgery 40:724–729 1997

9.

Zdeblick TAZou DWarden KEet al: Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am) 74:22271992Zdeblick TA Zou D Warden KE et al: Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am) 74:22–27 1992

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 24 24 12
Full Text Views 68 68 8
PDF Downloads 84 84 8
EPUB Downloads 0 0 0

PubMed

Google Scholar