Anterior Full-endoscopic Single-port Double Transcorporeal Spinal Cord Decompression for Noncontinuous Two-segment Cervical Spondylotic Myelopathy: A Technical Note

Abstract

Objective: In clinical practice, noncontinuous two-segment spinal cord cervical spondylosis is a particular form of cervical degenerative disease. Traditional anterior open surgery frequently comes with severe trauma, risks, and debatable treatment options. This study aimed to describe for the first time a novel minimally invasive technique, namely, anterior full-endoscopic single-port double transcorporeal spinal cord decompression for the treatment of patients with noncontinuous two-segment cervical spondylotic myelopathy.

Method: From February 2020 to May 2021, five patients with noncontinuous two-segment cervical spondylotic myelopathy were treated with anterior full-endoscopic single-port double transcorporeal spinal cord decompression. Two bone channels were established by the trephine through the vertebral body oblique upward and downward to the herniated disc osteophyte complex, and the full-endoscopic system could decompress the spinal cord through the channels. All cases were followed up for over 2 years. The modified Japanese Orthopaedic Association (mJOA) score and visual analogue scale (VAS) score before and after operation and during follow-up were used to evaluate the clinical effectiveness. Radiological examinations, including CT and MRI, were utilized to evaluate the efficacy of spinal cord decompression and bone channel repair.

Results: All operations were successfully completed and the average operation time was 185 min, with no operation-related complications. Compared with the preoperative evaluation, the mJOA score and VAS score were improved at each time point after operation and follow-up. Postoperative CT and MRI scans showed that the intervertebral disc-osteophyte complex was removed through the vertebral bone passage, and the spinal cord was fully decompressed. After 24 months of follow-up, CT and MRI scans showed that the bone channel was almost repaired and healed.

Conclusion: Anterior full-endoscopic single-port double transcorporeal spinal cord decompression is an effective minimally invasive technique for noncontinuous two-segment cervical spondylosis. It provides precise and satisfactory spinal cord decompression under endoscopic visualization with minimum trauma.

Keywords

Cervical spondylotic myelopathy / Full-endoscopic operation / Minimally invasive spine surgery / Noncontiguous levels / Transcorporeal approach

References

[1] Qizhi S, Peijia L, Lei S, Junsheng C, Jianmin L. Anterior cervical discectomy and fusion for noncontiguous cervical spondylotic myelopathy. Indian J Orthop. 2016;50:390–396.

[2] Badhiwala JH, Ahuja CS, Akbar MA, Witiw CD, Nassiri F, Furlan JC, et al. Degenerative cervical myelopathy—update and future directions. Nat Rev Neurol. 2020;16:108–124.

[3] Tetreault LA, Côté P, Kopjar B, Arnold P, Fehlings MG, AOSpine North America and International Clinical Trial Research Network. A clinical prediction model to assess surgical outcome in patients with cervical spondylotic myelopathy: internal and external validations using the prospective multicenter AOSpine North American and international datasets of 743 patients. Spine J. 2015;15:388–397.

[4] Bisson EF, Samuelson MM, Apfelbaum RI. Intermediate segment degeneration after noncontiguous anterior cervical fusion. Acta Neurochir. 2011;153:123–127. discussion 128.

[5] Xue R, Ji Z, Cheng X, Zhang ZQ, Zhang F. Risk factors for dysphagia after anterior cervical discectomy and fusion with the zero-P implant system: a study with minimum of 2 years follow-up. Orthop Surg. 2022;14:149–156.

[6] Veeravagu A, Cole T, Jiang B, Ratliff JK. Revision rates and complication incidence in single- and multilevel anterior cervical discectomy and fusion procedures: an administrative database study. Spine J. 2014;14:1125–1131.

[7] Wu T, He J, Huang K, Rong X, Ding C, Wang BY, et al. Cervical disc arthroplasty for the treatment of noncontiguous cervical degenerative disc disease: results of mid- to long-term follow-up. Orthop Surg. 2023;15:2901–2910.

[8] Lu Y, Bao W, Wang Z, Zhou F, Zou J, Jiang W, et al. Comparison of the clinical effects of zero-profile anchored spacer (ROI-C) and conventional cage-plate construct for the treatment of noncontiguous bilevel of cervical degenerative disc disease (CDDD): a minimum 2-year follow-up. Medicine (Baltimore). 2018;97:e9808.

[9] Qin R, Chen X, Zhou P, Li M, Hao J, Zhang F. Anterior cervical corpectomy and fusion versus posterior laminoplasty for the treatment of oppressive myelopathy owing to cervical ossification of posterior longitudinal ligament: a meta-analysis. Eur Spine J. 2018;27:1375–1387.

[10] Wu T, Meng Y, Wang B, Rong X, Hong Y, Ding C, et al. Biomechanics following skip-level cervical disc arthroplasty versus skip-level cervical discectomy and fusion: a finite element-based study. BMC Musculoskelet Disord. 2019;20:49.

[11] Wu T, Wang B, Ding C, Meng Y, Lou J, Yang Y, et al. Artificial cervical disc replacement with the prestige-LP prosthesis for the treatment of non-contiguous 2-level cervical degenerative disc disease: a minimum 24-month follow-up. Clin Neurol Neurosurg. 2017;152:57–62.

[12] Wu T-K, Wang B-Y, Cheng D, Rong X, Lou J-G, Hong Y, et al. Clinical and radiographic features of hybrid surgery for the treatment of skip-level cervical degenerative disc disease: a minimum 24-month follow-up. J Clin Neurosci. 2017;40:102–108.

[13] Wu T-K, Wang B-Y, Deng M-D, Hong Y, Rong X, Chen H, et al. A comparison of anterior cervical discectomy and fusion combined with cervical disc arthroplasty and cervical disc arthroplasty for the treatment of skip-level cervical degenerative disc disease: a retrospective study. Medicine (Baltimore). 2017;96:e8112.

[14] Zhang Z, Li Y, Jiang W. A comparison of zero-profile anchored spacer (ROI-C) and plate fixation in 2-level noncontiguous anterior cervical discectomy and fusion- a retrospective study. BMC Musculoskelet Disord. 2018;19:119.

[15] Sun X, Sun S, Zhang T, Kong C, Wang W, Lu S. Biomechanical comparison of noncontiguous cervical disc arthroplasty and noncontiguous cervical discectomy and fusion in the treatment of noncontinuous cervical degenerative disc disease: a finite element analysis. J Orthop Surg Res. 2020;15:36.

[16] Shi S, Liu Z-D, You W-J, Ouyang YP, Li XF, Qian L, et al. Application of a stand-alone anchored spacer in noncontiguous anterior cervical arthrodesis with radiologic analysis of the intermediate segment. J Clin Neurosci. 2016;25:69–74.

[17] Oppenheimer JH, DeCastro I, McDonnell DE. Minimally invasive spine technology and minimally invasive spine surgery: a historical review. Neurosurg Focus. 2009;27:E9.

[18] Ahn Y. The current state of cervical endoscopic spine surgery: an updated literature review and technical considerations. Expert Rev Med Devices. 2020;17:1285–1292.

[19] Kong W, Xin Z, Du Q, Cao G, Liao W. Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord for single-segment cervical spondylotic myelopathy: the technical interpretation and 2 years of clinical follow-up. J Orthop Surg Res. 2019;14:461.

[20] Chang C-J, Liu Y-F, Hsiao Y-M, Chang WL, Hsu CC, Liu KC, et al. Full endoscopic spine surgery for cervical spondylotic myelopathy: a systematic review. World Neurosurg. 2023;175:142–150.

[21] Ren Y, Yang J, Chen C-M, Liu K, Wang XF, Wei JM, et al. Outcomes of discectomy by using full-endoscopic visualization technique via the transcorporeal and transdiscal approaches in the treatment of cervical intervertebral disc herniation: a comparative study. Biomed Res Int. 2020;2020:5613459.

[22] Tzaan W-C. Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation: outcome, complications, and technique. J Spinal Disord Tech. 2011;24:421–431.

[23] Deng Z-L, Chu L, Chen L, Yang JS. Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the C4-C5 levels: a technical note. Spine J. 2016;16:659–666.

[24] Du Q, Wang X, Qin J-P, Friis T, Kong W-J, Cai Y-Q, et al. Percutaneous full-endoscopic anterior transcorporeal procedure for cervical disc herniation: a novel procedure and early follow-up study. World Neurosurg. 2018;112:e23–e30.

[25] Quillo-Olvera J, Lin GX, Suen TK, Jo HJ, Kim JS. Anterior transcorporeal tunnel approach for cervical myelopathy guided by CT-based intraoperative spinal navigation: Technical note. J Clin Neurosci. 2018;48:218–223.

[26] Kato S, Fehlings M. Degenerative cervical myelopathy. Curr Rev Musculoskelet Med. 2016;9:263–271.

[27] Youn MS, Shon MH, Seong YJ, Shin JK, Goh TS, Lee JS. Clinical and radiological outcomes of two-level endoscopic posterior cervical foraminotomy. Eur Spine J. 2017;26:2450–2458.

[28] Parihar VS, Yadav N, Ratre S, Dubey A, Yadav YR. Endoscopic anterior approach for cervical disc disease (disc preserving surgery). World Neurosurg. 2018;115:e599–e609.

[29] Zhao X-B, Ma Y-J, Ma H-J, Zhang XY, Zhou HG. Clinical efficacy of posterior percutaneous endoscopic unilateral laminotomy with bilateral decompression for symptomatic cervical spondylotic myelopathy. Orthop Surg. 2022;14:876–884.

[30] Ahn Y, Keum HJ, Shin SH. Percutaneous endoscopic cervical discectomy versus anterior cervical discectomy and fusion: a comparative cohort study with a five-year follow-up. J Clin Med. 2020;9:371.

[31] Carr DA, Abecassis IJ, Hofstetter CP. Full endoscopic unilateral laminotomy for bilateral decompression of the cervical spine: surgical technique and early experience. J Spine Surg. 2020;6:447–456.

[32] Choi G, Pophale CS, Patel B, Uniyal P. Endoscopic spine surgery. J Korean Neurosurg Soc. 2017;60:485–497.

[33] Ju CI, Kim P, Seo JH, Kim SW, Lee SM. Complications of cervical endoscopic spinal surgery: a systematic review and narrative analysis. World Neurosurg. 2023;178:330–339.

[34] Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop. 2009;33:1677–1682.

[35] Chen X, Gao J-A, Du Q, Qiao Y, Kong W-J, Liao W-B. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy for the treatment of cervical disc herniation: surgical design and results. Pain Physician. 2021;24:E811–E819.

[36] Qiao Y, Liao W-B, Du Q, Ao J, Cai Y-Q, Kong W-J, et al. Percutaneous full-endoscopic anterior transcorporeal diskectomy for massive migrated cervical disk herniation treatment: case report and review of the literature. World Neurosurg. 2019;132:47–52.

[37] Kim J-S, Eun SS, Prada N, Choi G, Lee SH. Modified transcorporeal anterior cervical microforaminotomy assisted by O-arm-based navigation: a technical case report. Eur Spine J. 2011;20(Suppl 2):S147–S152.

[38] Kim TT, Johnson JP, Pashman R, Drazin D. Minimally invasive spinal surgery with intraoperative image-guided navigation. Biomed Res Int. 2016;2016:5716235.

[39] Chu L, Yang J-S, Yu K-X, Chen CM, Hao DJ, Deng ZL. Usage of bone wax to facilitate percutaneous endoscopic cervical discectomy via anterior transcorporeal approach for cervical intervertebral disc herniation. World Neurosurg. 2018;118:102–108.

[40] Du Q, Lei L-Q, Cao G-R, Kong W-J, Ao J, Wang X, et al. Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report. BMC Musculoskelet Disord. 2019;20:280.

[41] Andrzejowski P, Giannoudis PV. The ‘diamond concept’ for long bone non-union management. J Orthop Traumatol. 2019;20:21.

RIGHTS & PERMISSIONS

2024 2024 The Authors. Orthopaedic Surgery published by Tianjin Hospital and John Wiley & Sons Australia, Ltd.