Endoscopic Resection of Symptomatic Cervical Facet Cyst in Ankylosing Spondylitis

Full Endoscopic Spine Surgery for Cervical Spondylotic Myelopathy: A Systematic Review

BACKGROUND

Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine surgery in the treatment of CSM. The main purpose of this study was to conduct a systematic review to elucidate the efficacy of full endoscopic spine surgery in the management of patients with CSM.

METHODS

This systematic review was conducted in accordance with the PRISMA guidelines. A systematic search of Web of Science, PubMed MEDLINE, Embase, and Cochrane Library was conducted from the database inception to February 1, 2023.

RESULTS

The study included 183 patients and their age was 56.78 ± 7.87 years. The average surgical time calculated was 96.34 ± 33.58 minutes. Intraoperative blood loss ranged from a minimal amount to 51 mL. The average duration of hospital stay was 3.56 ± 1.6 days. The average span for follow-up was on an interval of 18.7 ± 6.76 months. Significant improvements were noted in all aspects of functional outcomes and image results after full endoscopic cervical spine surgery, with no major complications.

CONCLUSIONS

The current study found that both anterior transcorporeal and posterior surgical approaches could be used for the treatment of CSM with a full endoscopic technique. Indications of full endoscopic cervical spine surgery for CSM included cervical disc herniation, central canal stenosis, calcified ligamentum flavum, and ossification of the posterior longitudinal ligament. Improved postoperative outcomes with acceptable surgical complications were noted in this systematic review.

Unilateral biportal endoscopic supralaminar, posterior spinous process sparing approach for en bloc cervical laminectomy in case of cervical osteochondroma causing myelopathy: A case report

Background Context

Cervical osteochondroma is a rare cause of myelopathy. Traditional treatment is open laminectomy with or without fusion. There is limited literature on unilateral bi-portal endoscopic en-bloc resection of cervical osteochondroma.

Study Design

We describe a case of a 39-year-old male diagnosed with cervical compressive myelopathy. The pathologic site is located on the ventral surface of C4 lamina. Herein we describe a step-by-step method of unilateral biportal endoscopy (UBE) en-bloc resection of extra-dural sublaminar osteochondroma for patient who had cervical myeloradiculopathy. Spinous process sparing osteotomy was performed to conserve the spinous process and supraspinous ligament..

Outcome Measures

The patient was successfully treated via UBE and the operative time was 50 minutes with no intra-operative complications. Patient symptoms improved in the immediate postoperative period and by 3 months he regained fine motor functions of hand.

Conclusions

Unilateral biportal endoscopic en bloc cervical laminectomy can effectively decompress cervical spine and remove posterior benign cervical tumor. UBE preserves musculature and posterior ligamentous complex and thus reduces postoperative neck pain and postlaminectomy kyphosis.

Surgical Removal of Cervical Extradural Cysts Using the Biportal Endoscopic Approach

BACKGROUND

Symptomatic intraspinal extradural cysts of the cervical spine are uncommon; however, they are usually treated using conventional posterior decompression. Biportal endoscopic surgery is widely used to treat degenerative cervical pathological conditions. This study presented an optimized surgical technique for a biportal endoscopic posterior approach for removal of cervical intraspinal extradural cysts that caused cervical radiculomyelopathy.

METHODS

A broad laminotomy was performed, which was wider than the outer contour of the cysts. The ligamentum flavum was detached from the bony margin and removed after an epidural dissection, and a dense adhesive tissue entrapped the extradural cysts. A spinal endoscope was placed close to the dissection plane and offered a high-resolution magnified view. The cyst capsule was safely dissected from the dura and removed en bloc without dural injury.

RESULTS

Postoperatively, neurological deficits, including cervical myelopathy, radiating arm pain, and upper back pain improved in both patients.

CONCLUSIONS

We successfully removed an extradural cervical cystic mass lesion by using a biportal endoscopic posterior cervical approach without complications. The biportal endoscopic approach may have advantages, such as minimizing trauma to the normal structures of the posterior cervical region, magnified endoscopic view, and early recovery after the surgery. Biportal endoscopy may be used as an alternative surgical treatment for symptomatic cervical intraspinal extradural cystic lesions.

Facet cysts in the subaxial cervical spine: Case series focused on radiological and histopathological findings with a scoping review

BACKGROUND

Facet cysts in the subaxial cervical spine are a relatively rare cause of neuropathy. This case series aimed to investigate the radiological and histopathological features and surgical results of these lesions, and provide possible mechanisms of cyst development.

METHODS

Thirteen subaxial cervical facet cysts in 12 patients were diagnosed on the basis of magnetic resonance imaging and computed tomography with facet arthrography. Surgical outcomes were evaluated according to the Japanese Orthopaedic Association scores for cervical myelopathy, or Tanaka's scores for cervical radiculopathy. These results were presented in combination with a scoping review of the literature.

RESULTS

Seven cysts were found in the posteromedial region, and six in the posterolateral portion of the spinal canal. Computed tomography revealed degeneration of all involved facet joints. All patients underwent decompression, and the mean recovery rates of Japanese Orthopaedic Association scores and Tanaka's scores were 57.1% and 87.5%, respectively. Histopathologically, all cysts were continuous with the degenerated ligamentum flavum. In the scoping review, the patients' mean age was 65.1 years. The cysts were distributed as follows: 3.6% at C2-3, 10.7% at C3-4, 14.3% at C4-5, 5.4% at C5-6, 7.1% at C6-7, and 58.9% at C7-T1. The presenting symptoms were myelopathy (49.4%) and radiculopathy (50.0%). Radiologically, 55% and 45% of the cysts were of the posteromedial and posterolateral types. Of the patients, 76.9% underwent decompression only, and 23.1% had concomitant fusion. Cyst recurrence was not observed in the mean follow-up period of 15.1 months.

CONCLUSIONS

The pathogenesis of cysts is closely related to degenerative changes in the facet joint and ligamentum flavum, and rupture in degenerated ligaments can develop into a cavity, which contributes to cyst formation. The scoping review suggests that cyst resection generally results in positive outcomes without recurrence in either decompression alone or concomitant fusion.

Posterior Endoscopic Cervical Decompression: Review and Technical Note

Endoscopic spine surgery for the treatment of degenerative spinal diseases from lumbar to cervical spine has accelerated over the past 2 decades. Posterior endoscopic cervical discectomy (PECD) has been described as a safe, effective, and minimally invasive procedure for cervical radiculopathy or even part of the myelopathy. This procedure also has been validated with comparable outcomes to open and microscopic surgery. Radiculopathy due to foraminal disc herniation or foraminal stenosis should be the optimum indications of this procedure. Intraoperative 3-dimensional navigation can help surgeons to get quick and great quality guidance for endoscopic surgeons. In this review, we will focus on the technical details and evidence-based results of PECD which is a promising procedure for cervical radiculopathy with the advantages of a minimally invasive method.