Minimally Invasive Spine Surgery Endoscopic Postrior Cervical Foraminotomy

Transcription

1 Minimally Invasive Spine Surgery Endoscopic Postrior Cervical Foraminotomy Benedikt Burkhardt Department of Neurosurgery, Saarland University Medical Center, Homburg/Saar, Germany

2 Background The managment of cervical radiculopathy is a controversial area in spine surgery Open Posterior Cervical Foraminotomy is an effective treatment for lateral cervical disc herniation or foraminal stenosis Spurling and Scoville as well as Frykholm in the 1940s 1

3 Background Advantages of posterior approach No risk of injury to the anterior structures Better exposure for decompression of exiting nerve root and access to eccentrically located disc fragments and osseous foraminal stenosis Disadvantages of the open posterior approach Difficulty in resecting osteophytes and medially localized disc herniation Excessive blood loss via epidural veins Increased post-operative muscle spasm, neck pain, and prolonged recovery time Even spinal instability. 2

4 Background Development of new minimally invasive techniques (fullendoscopic or tubular) to reduce iatrogenic approach-related trauma blood loss, pain medication hospital stay superior aesthetic result 3

5 Background 4

6 Background Less than 10 studies using endoscopic technique for posterior approach Microscope or magnifying glasses instead of an endoscope or even an anterior approach 5

7 Background Majority of studies do not analyze the outcome separated by diagnosis Only two reports of endoscopic posterior approach for pure osseous neuroforaminal stenosis 6

8 Literature Two studies reported about clinical outcome after endoscopic posterior foraminotomy for neuroforaminal stenosis 7

9 Surgical technique Patient positioning Concord position 8

10 Surgical technique Patient positioning Semisitting position Posterior Minimally Invasive Approaches for the Cervical Spine Vishal C. Gala, MD, MPH, John E. O Toole, MD, Jean-Marc Voyadzis, MD, Richard G. Fessler, MD, PhD Orthop Clin N Am 38 (2007)

11 Posterior approach EasyGO 2.Generation, Karl Storz Company 9

12 Endoscopic visualization 10

13 Endoscopic visualization 10

14 Postoperative CT-scan Case: 69 year old male patient (24 month follow) It took 6 month to regain full motor strengh No senso-motory deficits. No pain 11

15 Aesthetic outcome Two level unilateral endoscopic tubular assisted Frykholm procedure (C5/6 & C6/7) Postoperative wound (about 13mm) 12

16 Patient demographics 45 patients (28 male and 17 female) Mean age: 55.6 years (range: years) 1-level procedure: 33 patients 2-level procedure: 11 patients 3-level procedure: 1 patient Unilateral procedure: 41 patients Bilateral procedure 4 patients 20 patients without previous cervical spine surgery 25 patients with previous cervical spine surgery 13

17 Intraoperative findings 7 procedures with a 15mm working trocar 38 procedures with a 19mm working trocar No emergency stopping No CSF leaks, no nerve root injury One revision surgery due to postoperative bleeding 14

18 Results Pain Without Previous Surgery With previous surgery Preoperative 85.7% 95.8% Postoperative (painfree/reduction) Paresis 100.0% 91.7% Preoperative 38.7% 62.5% Postoperative (no paresis /reduction, 1week) Postoperative (no paresis, 6 month) 87.5% 60.0% 100.0% 73.3% 15

19 Results Sensory deficit Without Previous Surgery With previous surgery Preoperative Postoperative (no/reduction) Clinical success 95.0% 76.0% Neck disability index 12% 24% Preoperative radiographic C2-7 lordosis 55.0% 28.0% 16

20 Conclusion The endoscopic posterior approach for foraminotomy in neuroforaminal stenosis is a safe technique Overall clincial success rate is 84.4% Patients with a history of cervical spine surgery suffering from osseous foraminal stenosis have lower clinical success rate than patients without previous surgery 17

21 Thank you 18