Ten-Step Minimally Invasive Cervical Decompression via Unilateral Tubular Laminotomy: Technical Note and Early Clinical Experience.

Decompression, Surgical Humans Laminectomy Retrospective Studies Spinal Stenosis / surgery Treatment Outcome
Cervical laminectomy Cervical laminotomy Cervical spondylotic myelopathy Minimally invasive spine surgery Technical report Tubular retractor ULBD Unilateral laminotomy for bilateral decompression

Journal

Operative neurosurgery (Hagerstown, Md.)
ISSN: 2332-4260
Titre abrégé: Oper Neurosurg (Hagerstown)
Pays: United States
ID NLM: 101635417

Informations de publication

Date de publication:
01 03 2020
Historique:
received: 12 09 2018
accepted: 18 03 2019
pubmed: 28 6 2019
medline: 22 6 2021
entrez: 28 6 2019
Statut: ppublish

Résumé

Minimally invasive techniques utilizing tubular retractors have become an increasingly popular approach to the spinal column. The concept of a unilateral laminotomy for bilateral decompression (ULBD), first applied in the lumbar spine, has recently been applied to the cervical spine for the treatment of cervical spondylotic myelopathy (CSM). A better understanding of the indications and surgical techniques is required to effectively educate surgeons on how to appropriately and safely perform tubular cervical laminotomy via ULBD. To describe a 10-step technique for minimally invasive cervical laminotomy and report our early clinical experience. A retrospective review identified 15 patients with CSM who were treated with this procedure. Visual analogue scale (VAS), neck disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) scores were obtained pre- and postoperatively. The mean age of the 15 patients was 73.1 ± 6.8 yr. The median number of levels treated was 1 (range 1-3). Mean operative time was 125.3 ± 30.8 or 81.7 ± 19.2 min per level. Mean estimated blood loss was 57.3 ± 24.6 cc. Median postoperative hospital length of stay was 36 h. No complications were encountered. Median follow-up was 18 mo. Mean pre- and postoperative VAS were 6.4 ± 2.4 and 1.0 ± 0.8, respectively (P < .001). Mean pre- and postoperative NDI were 46.4 ± 19.2 and 7.0 ± 6.9, respectively (P < .001). Mean pre- and postoperative Mjoa were 11.3 ± 2.5 and 14.5 ± 0.5, respectively (P < .001). In our early clinical experience, minimally invasive cervical ULBD is safe and effective. Adherence to the presented 10-step technique will allow surgeons to safely address bilateral cervical pathology while avoiding complications.

Sections du résumé

BACKGROUND
Minimally invasive techniques utilizing tubular retractors have become an increasingly popular approach to the spinal column. The concept of a unilateral laminotomy for bilateral decompression (ULBD), first applied in the lumbar spine, has recently been applied to the cervical spine for the treatment of cervical spondylotic myelopathy (CSM). A better understanding of the indications and surgical techniques is required to effectively educate surgeons on how to appropriately and safely perform tubular cervical laminotomy via ULBD.
OBJECTIVE
To describe a 10-step technique for minimally invasive cervical laminotomy and report our early clinical experience.
METHODS
A retrospective review identified 15 patients with CSM who were treated with this procedure. Visual analogue scale (VAS), neck disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) scores were obtained pre- and postoperatively.
RESULTS
The mean age of the 15 patients was 73.1 ± 6.8 yr. The median number of levels treated was 1 (range 1-3). Mean operative time was 125.3 ± 30.8 or 81.7 ± 19.2 min per level. Mean estimated blood loss was 57.3 ± 24.6 cc. Median postoperative hospital length of stay was 36 h. No complications were encountered. Median follow-up was 18 mo. Mean pre- and postoperative VAS were 6.4 ± 2.4 and 1.0 ± 0.8, respectively (P < .001). Mean pre- and postoperative NDI were 46.4 ± 19.2 and 7.0 ± 6.9, respectively (P < .001). Mean pre- and postoperative Mjoa were 11.3 ± 2.5 and 14.5 ± 0.5, respectively (P < .001).
CONCLUSION
In our early clinical experience, minimally invasive cervical ULBD is safe and effective. Adherence to the presented 10-step technique will allow surgeons to safely address bilateral cervical pathology while avoiding complications.

Identifiants

DOI: 10.1093/ons/opz156 PMID: 31245806
pubmed: 31245806
pii: 5523882
doi: 10.1093/ons/opz156
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

284-294

Commentaires et corrections

Type : CommentIn

Informations de copyright

Copyright © 2019 by the Congress of Neurological Surgeons.

Auteurs

Robert Nick Hernandez (RN)

Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.

Christoph Wipplinger (C)

Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.
Department of Neurosurgery, Medical University of Innsbruck, Innsbruck, Austria.

Rodrigo Navarro-Ramirez (R)

Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.

Sergio Soriano-Solis (S)

Soriano Institute for Minimally Invasive Spine Surgery, ABC Hospital, Mexico City, Mexico.

Sertac Kirnaz (S)

Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.

Ibrahim Hussain (I)

Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.

Franziska Anna Schmidt (FA)

Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.

José-Antonio Soriano-Sánchez (JA)

Soriano Institute for Minimally Invasive Spine Surgery, ABC Hospital, Mexico City, Mexico.

Roger Härtl (R)

Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York.

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Classifications MeSH

questionsmedicales.fr › Procédures de chirurgie opératoire › Décompression chirurgicale › Ten-Step Minimally Invasive Cervical...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Ten-Step Minimally Invasive Cervical...
questionsmedicales.fr › Procédures de chirurgie opératoire › Procédures orthopédiques › Laminectomie › Ten-Step Minimally Invasive Cervical...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Caractéristiques des études épidémiologiques › Études épidémiologiques › Études de cohortes › Études rétrospectives › Ten-Step Minimally Invasive Cervical...
questionsmedicales.fr › Maladies ostéomusculaires › Maladies osseuses › Maladies du rachis › Sténose du canal vertébral › Ten-Step Minimally Invasive Cervical...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Ten-Step Minimally Invasive Cervical...