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Hernandez RN, Wipplinger C, Navarro-Ramirez R, Soriano-Solis S, Kirnaz S, Hussain I, Schmidt FA, Soriano-Sánchez JA, Härtl R. Ten-Step Minimally Invasive Cervical Decompression via Unilateral Tubular Laminotomy: Technical Note and Early Clinical Experience. Oper Neurosurg (Hagerstown) 2021; 18:284-294. [PMID: 31245806 DOI: 10.1093/ons/opz156] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 03/18/2019] [Indexed: 11/15/2022] Open
Abstract
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.
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Affiliation(s)
- Robert Nick Hernandez
- 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
- 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
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Sergio Soriano-Solis
- Soriano Institute for Minimally Invasive Spine Surgery, ABC Hospital, Mexico City, Mexico
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | - Franziska Anna Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
| | | | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, New York-Presbyterian/Weill Cornell Medicine, New York, New York
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Hussain I, Schmidt FA, Kirnaz S, Wipplinger C, Schwartz TH, Härtl R. MIS approaches in the cervical spine. JOURNAL OF SPINE SURGERY 2019; 5:S74-S83. [PMID: 31380495 DOI: 10.21037/jss.2019.04.21] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Minimally invasive surgical approaches for the treatment of spinal pathologies have accelerated over the past three decades and resulted in superior functional outcomes with less complications. Yet cervical pathologies have been slower to gain traction for multiple anatomical factors and its "high-risk" profile. Various minimally invasive techniques for cervical disease have now been described and validated in long-term studies with comparable outcomes to traditional open approaches and concomitant reduction in morbidity and socioeconomic costs. Transnasal operations can be used to treat ventral upper cervical disease, circumventing traditional and morbid transoral approaches. Posterior-based focused treatments for radiculopathy and myelopathy such as tubular-guided foraminotomies and unilateral laminotomies for bilateral cord decompression have also been described and becoming increasingly less invasive. Cervical fusions can now be performed percutaneously through modified, stand-alone facet joint cages that can be packed with allogeneic bone graft. These advances have been facilitated by the development of intraoperative imaging technologies (intraoperative CT) and 3-dimensional stereotactic navigation software. While this review focuses on these procedures and evidence-based outcomes data, the future for MIS applications in cervical spine surgery will continue to evolve over the coming years with wider indications and technological adjuncts.
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Affiliation(s)
- Ibrahim Hussain
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Franziska A Schmidt
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Sertac Kirnaz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Christoph Wipplinger
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Theodore H Schwartz
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
| | - Roger Härtl
- Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell, Medical College, New York Presbyterian Hospital, New York, NY, USA
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Perikal PJ, Srikantha U, Jagannath AT, Khanapure K, Varma RG, Hegde AS. Rare manifestation of common disease with an unique method of minimally invasive spine stabilization: Cervical 2-3 facet lesion. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2018; 9:209-211. [PMID: 30443143 PMCID: PMC6187890 DOI: 10.4103/jcvjs.jcvjs_69_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cervical granulomatous infections of the posterior elements are very rare, it is often difficult to diagnose due to rarity and variable presentation of symptoms. Any cervical surgical procedure carries a certain morbid risk to the patient. We present a case of cervical 2-3 facet joint lesion which was managed by a minimally invasive technique with a favorable outcome.
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Affiliation(s)
- Parichay J Perikal
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Umesh Srikantha
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India
| | - Aniruddha T Jagannath
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Kiran Khanapure
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
| | - Ravi Gopal Varma
- Department of Neurosurgery, Aster CMI Hospital, Bangalore, Karnataka, India
| | - A S Hegde
- Department of Neurosurgery, Ramaiah Institute of Neurosciences, M S Ramaiah Medical College, Bangalore, Karnataka, India
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Spanos SL, Siasios ID, Dimopoulos VG, Paterakis KN, Mastrogiannis DS, Giannis TP, Fotiadou AA, Pollina J, Fountas KN. Correlation of Clinical and Radiological Outcome After Anterior Cervical Discectomy and Fusion With a Polyetheretherketone Cage. J Clin Med Res 2018; 10:268-276. [PMID: 29416588 PMCID: PMC5798276 DOI: 10.14740/jocmr3326w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 01/08/2018] [Indexed: 12/03/2022] Open
Abstract
Background Anterior cervical discectomy and fusion (ACDF) with a polyetheretherketone (PEEK) cage is considered as the gold standard for patients with cervical disc disease. However, there are limited in vivo data on the impact of ACDF on the cervical kinematics and its association with patient-reported clinical outcomes. The purpose of this study was to investigate the impact of altered cervical sagittal alignment (cervical lordosis) and sagittal range of motion (ROM) on patients’ self-reported pain and functional disability, after ACDF with a PEEK cage. Methods We prospectively studied 74 patients, who underwent single-, or consecutive two-level ACDF with a PEEK interbody cage. The clinical outcomes were assessed by using the pain numeric rating scale (NRS) and the neck disability index (NDI). Radiological outcomes included cervical lordosis and C2-C7 sagittal ROM. The outcome measures were collected preoperatively, at the day of patients’ hospital discharge, and also at 6 and 12 months postoperatively. Results There was a statistically significant reduction of the NRS and NDI scores postoperatively at each time point (P < 0.005). Cervical lordosis and also ROM significantly reduced until the last follow-up (P < 0.005). There was significant positive correlation between NRS and NDI preoperatively, as well as at 6 and 12 months postoperatively (P < 0.005). In regard to the ROM and the NDI scores, there was no correlation preoperatively (P = 0.199) or postoperatively (6 months, P = 0.322; 12 months, P = 0.476). Additionally, there was no preoperative (P = 0.134) or postoperative (6 months, P = 0.772; 12 months, P = 0.335) correlation between the NDI scores and cervical lordosis. Conclusions In our study, reduction of cervical lordosis and sagittal ROM did not appear to significantly influence on patients’ self-reported disability. Such findings further highlight the greater role of pain level over the mechanical limitations of ACDF with a PEEK cage on patients’ own perceived recovery.
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Affiliation(s)
- Savvas L Spanos
- Department of Neurosurgery, School of Medicine, University of Thessaly, Larissa, Greece.,Department of Physiotherapy, School of Health and Welfare, Technological Education Institute of Sterea Ellada, Lamia, Greece
| | - Ioannis D Siasios
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, NY, USA.,Department of Neurosurgery, Papageorgiou Hospital, Thessaloniki, Greece
| | - Vassilios G Dimopoulos
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, NY, USA
| | | | - Dimos S Mastrogiannis
- Department of Nursing, School of Health and Welfare, Technological Education Institute of Sterea Ellada, Lamia, Greece
| | | | - Aggeliki A Fotiadou
- Department of Neurosurgery, School of Medicine, University of Thessaly, Larissa, Greece
| | - John Pollina
- Department of Neurosurgery, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, USA.,Department of Neurosurgery, Kaleida Health, Buffalo, NY, USA
| | - Kostas N Fountas
- Department of Neurosurgery, School of Medicine, University of Thessaly, Larissa, Greece.,Department of Neurosurgery, University Hospital of Larissa, Larissa, Greece
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Whitfield P, Yuen J. https://www.acnr.co.uk/2017/09/anterior-cervical-discectomy-and-fusion-acdf-for-degenerative-cervical-diseases-six-decades-on/. ADVANCES IN CLINICAL NEUROSCIENCE & REHABILITATION 2017. [DOI: 10.47795/iwdk8512] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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