Endoscopic Posterior Approach for Cervical Myelopathy and Radiculopathy Using Tubular Retractor: Our Experience, Surgical Technique, and Literature Review

• Published in: World neurosurgery 2024-10, Vol.190, p.e622-e636
• Main Authors: Sharma, Mukesh, Yadav, Nishtha, Ratre, Shailendra, Bajaj, Jitin, Kavishwar, Arvind, Hadaoo, Ketan, Patidar, Jayant, Sinha, Mallika, Parihar, Vijay, Swamy, Narayan M., Yadav, Yad Ram
• Format: Article
• Language: English
• Subjects: Adult; Aged; Aged, 80 and over; Cervical spine; Cervical spondylosis; Cervical Vertebrae - surgery; Decompression, Surgical - methods; Disc disease; Endoscopic surgical procedures; Endoscopy; Female; Foraminotomy; Foraminotomy - methods; Humans; Male; Middle Aged; Minimally invasive surgery; Neuroendoscopy - methods; Radiculopathy - etiology; Radiculopathy - surgery; Retrospective Studies; Spinal Cord Compression - etiology; Spinal Cord Compression - surgery; Spinal Cord Diseases - surgery; Treatment Outcome
• ISSN: 1878-8750; 1878-8769; 1878-8769
• DOI: 10.1016/j.wneu.2024.07.193

Endoscopic posterior approach can effectively decompress cervical root and cord secondary to posterior compression. We present our experience in 229 patients using tubular retractor, and the relevant literature is reviewed. Retrospective analysis of multilevel myelopathy and or radiculopathy was performed. Indications for posterior approach was primary posterior compressions at cord and or root. Combined compression from posterior side and mild to moderate anterior pressure with acceptable lordosis were also decompressed. Bilateral cord decompression and foraminotomy for radiculopathy was performed using tubular retractor. Myelopathy and radiculopathy were present in 220 and 9 patients, respectively. A total of 53 foraminotomy procedures were performed in 36 patients. All patients showed improvement, with the mean preoperative Nurick grade decreasing from 2.72 ± 0.799 to 0.78 ± 0.911 after surgery. There was significant improvement in postoperative Nurick grades compared with preoperative grades (Z-value = 13.306, P < 0.0001). Operative results were better in patients with good preoperative Nurick grades (grades 1 and 2) compared with those with poorer grades (grades 3 and 4). Minor bleeding, small dural tear, and root injury were observed in 42, 4, and 8 patients, respectively. Endoscopic approach was effective and safe for root and cord decompression. This study was limited by its single-center, retrospective design, exclusion of some eligible patients, a short postoperative Nurick grade assessment period of 6 months, and absence of a comprehensive long-term postoperative biomechanical assessment. To validate these results, a prospective multicenter study addressing these limitations is needed.