Full-endoscopic cervical arcocristectomy for the treatment of spinal stenosis: results of a cadaver study

Abstract

Purpose Cervical spondylotic myelopathy is a multifactorial disease that is directly correlated by the degree of spinal stenosis. Surgery remains the best therapy. A posterior approach is often recommended in patients with multilevel dorsal cervical compression. Aim of the present experimental study was to evaluate the feasibility of a fullendoscopic arcocristectomy in a cadaver study. Methods We performed full-endoscopic arcocristectomy on ten formalin-fixed human cervical specimens. Before and after decompression we obtained high-resolution computerized tomography (CT) data to evaluate the diameter of the cervical spinal canal. Results Overall, surgery was possible on 55 segments in ten cadaver specimens. A mean increase of 4.1 mm (±1.2 mm) in the sagittal diameter of the cervical spinal canal could be achieved (p \ 0.05, t test). Conclusions The full-endoscopic arcrocristectomy is feasible and achieves a sufficient decompression. This minimal invasive technique protects most of the dorsal structures and therefore probably preserves biomechanical functions, which has to be proven in future studies.

Endoscopic decompression of cervical spondylotic myelopathy using posterior approach

“…Similar results of good recovery were observed in the literature at single [5,6,21] or multiple levels. [2,21] The outcomes of microendoscopic foraminotomy technique were comparable to the open surgical group. [22] A mean increase of 4.1 mm (±1.2 mm) in the sagittal diameter of the cervical spinal canal was achieved by posterior endoscopic arcocristectomy approach in cadavers.…”

“…[22] A mean increase of 4.1 mm (±1.2 mm) in the sagittal diameter of the cervical spinal canal was achieved by posterior endoscopic arcocristectomy approach in cadavers. [2] We were able to decompress foramina and cord at single or multiple levels. Similar observation of sufficient length of root decompression (about 5 mm) has been reported by minimal resection of facets, superior and inferior lamina by modified laminoforaminotomy using minimally invasive technique.…”

“…have been used to increase spinal canal diameter and remove compression from root or spinal canal in cervical compression. [2] Although microscopic-assisted approaches using tubular retractor can offer almost similar results compared to endoscopic posterior foraminotomy, [18][19][20] in cervical radicular pain, endoscopic technique permits better bilateral decompression of cord or the foramina with improved visualization especially at corners.…”

“…[3] Endoscopic posterior approaches are indicated in lateral and foraminal cervical disc herniations or spurs using laminoforaminotomy [4][5][6] and in multilevel compression due to spinal stenosis. [2] Endoscopic decompression obviates the need for muscle dissection and disruption of the posterior tension band that can prevent postlaminectomy kyphosis. [1] It does not require sacrifice of a cervical motion segment.…”

“…[1] Posterior approach is often recommended in multilevel posterior cervical compression when pathology is mainly from posterior side. [2] It is possible to treat this problem using a minimally invasive approach. [3] Endoscopic posterior approaches are indicated in lateral and foraminal cervical disc herniations or spurs using laminoforaminotomy [4][5][6] and in multilevel compression due to spinal stenosis.…”