From the Texas Back Institute in Plano, Texas.
ENDOSCOPY
21
Endoscopic Posterior Cervical Foraminotomy Stealth Surgery for the Treatment of Cervical Radiculopathy Posterior cervical foraminotomy (PCF) with or without discectomy is a well-established treatment for cervical radiculopathy. Unlike anterior cervical discectomy and fusion (ACDF), the traditional gold standard surgical treatment, PCF allows for nerve root decompression without the need for instrumentation and without sacrificing motion. It has been studied extensively and has been found to have clinical outcomes that are generally comparable to ACDF.1–3 One barrier to the more widespread utilization of PCF may be the increased muscle spasm, neck pain, and blood loss associated with open posterior approaches to the cervical spine.4,5 However, the development of less invasive techniques has decreased approach-related morbidity and made PCF a more appealing option than it had been in the past. Minimally invasive tubular approaches produce similar degrees of symptomatic relief to open foraminotomy but with less blood loss, immediate postoperative neck pain, analgesic use, and hospital length of stay.6,7 Endoscopic techniques allow surgeons to perform PCF in an even more atraumatic fashion. As might be expected, full-endoscopic PCF produces shorter hospital stays and less postoperat ive neck pain than other techniques without sacrificing clinical effectiveness. 8,9 The benefit of the
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endoscopic approach extends beyond si mply preser vat ion of the paraspinal soft tissues, however. The angled optics of the endoscope facilitate viewing deeper w it hin t he foraminal Peter B. Derman, MD, space, and the narrow endoscopMBA ic cannula can be directed in a more medial-to-lateral trajectory before abutting the spinous process than can a conventional tubular retractor. Both of these features permit more extensive undercutting of the facet joint, which allows for adequate expansion of the foraminal area while minimizing the degree of facet joint resection and may reduce the incidence of postoperative segmental hypermobility. 8 The surgical indications for endoscopic PCF are identical to those established for open or tubular approaches: foraminal stenosis due to disc herniation and/or osseous overgrowth in the absence of significant central stenosis, instability, or deformity.4 The operative technique is likewise similar to open or tubular PCF. My technique is briefly described as follows: • The patient is positioned prone on a Jackson frame with the head resting on a foam head holder and the arms down by the patient’s sides. Cranial traction is not employed.
Vertebral Columns
Spring 2022