Minimally invasive tubular access for posterior cervical foraminotomy with three-dimensional microscopic visualization and localization with anterior/posterior imaging |
| |
| Institution: | 1. Stockholm Spine Center, Löwenströmska Hospital, SE-194 89, Upplands Väsby, Sweden;2. Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska Universitetssjukhuset Solna (L1:00), 171 76 Stockholm, Sweden;3. Neuro-Orthopaedic Center, Ryhov Hospital, 553 05 Jönköping, Sweden;4. Department of Orthopaedics, Uppsala University Hospital, Akademiska sjukhuset, 751 85 Uppsala, Sweden;1. Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA;2. Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA;3. Division of Orthopaedics, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA;1. Guangzhou Institute of Traumatic Surgery, The Fourth Affiliated Hospital of Medical College, Jinan University, Guangzhou 510220, China;2. School of Pathology and Laboratory Medicine, University of Western Australia, Crawley, Western Australia 6009, Australia;1. Division of Spine, Department of Orthopaedics, University of British Columbia and Vancouver Coastal Health, 6th Floor Blusson Spinal Cord Centre, Vancouver, British Columbia V5Z 1M9, Canada;2. Department of Neurosurgery, John Hopkins University, Baltimore, MD, USA;3. Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON, Canada;4. Department of Neurosurgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, NY, USA;5. Department of Orthopaedics, McGill University, Montreal, QC, Canada;6. Department of Neurosurgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX, USA;7. Neural Repair and Regeneration, Toronto Western Hospital, Toronto, ON, Canada;8. Division of Orthopaedic Surgery, Toronto Western Hospital, University Health Network, University of Toronto, Toronto, ON, Canada;9. Department of Neurological Surgery, UCSF, San Francisco, CA, USA;10. Department of Neurological Surgery, Mayo Clinic, Rochester, MN, USA;1. Department of Neurosurgery, Scanmed – St. Raphael Hospital, 12 Bochenka Street, 30-693 Cracow, Poland;2. Andrzej Frycz Modrzewski Krakow University, 1 Gustawa Herlinga Grudzinskiego Street, 30-705 Cracow, Poland;1. Department of Orthopaedic Surgery, Walter Reed National Military Medical Center, 8901 Wisconsin Avenue, Building 19, Bethesda, MD 20889, USA;2. Department of Neurosurgery, Walter Reed National Military Medical Center, Bethesda, MD, USA;3. Division of Orthopaedics, Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA |
| |
| Abstract: | Background contextPosterior cervical foraminotomy allows decompression of the nerve root with preservation of motion. A previously described endoscopic technique utilizes minimally invasive muscle splitting with routine outpatient discharge.PurposeThe approach allows a modified tubular retraction system to be used with three-dimensional visualization and anterior/posterior fluoroscopic imaging, thus allowing easy visualization even in large patients. This approach also allows safe docking of the retractor system on the lateral mass, thus avoiding the cervical spinal canal during exposure.Study designProne position is utilized, with localization and docking of instrumentation accomplished with anterior/posterior fluoroscopy. Surgery is performed with microscope-facilitated, three-dimensional visualization.MethodsPatients were placed in the prone position. Spinal needle localization was used for initial localization followed by a stab wound and placement of a 14-mm tube using sequentially enlarging dilators. Frequent use of anterior/posterior fluoroscopy avoided inadvertent medial placement of the instruments in the canal. A standard neurocapable operating microscope was used with 10X magnification and 400-mm focal length.ResultsA new minimally invasive posterior cervical approach was performed on 222 patients without dural penetration.ConclusionsPosterior foraminal cervical surgery with three-dimensional access and localization with anterior/posterior fluoroscopic imaging allows safe, reproducible docking on the cervical spine with subsequent exploration of the foramen and routine outpatient discharge. Complications related to difficulty with lateral localization in the lower cervical spine, and with inadvertent entry into the cervical spinal canal with possible catastrophic result are thus avoided. |
| |
| Keywords: | |
| 本文献已被 ScienceDirect 等数据库收录！ |
|
