Minimally Invasive Posterior Cervical Foraminotomy Using 3-Dimensional Total Navigation: 2-Dimensional Operative Video

Abstract Minimally invasive posterior cervical foraminotomy (MPCF) has shown comparable outcomes to those of an open approach, with shorter operation times and length of hospital stays, as well as decreased blood loss and inpatient analgesic use. This surgical technique is mainly used to treat unilateral radiculopathy due to foraminal soft disc fragments or bone spurs. Three-dimensional (3D) navigation-guidance facilitates the surgical workflow, and it is utilized in planning the incision, determining the extent of the medial facetectomy, and confirming sufficient decompression, especially in the lower cervical spine and cervicothoracic junction, where the shoulders make localization with fluoroscopy difficult. In this video, we present the case of a 49-yr-old male patient with mechanical neck pain and C8 radiculopathy due to multilevel cervical spinal stenosis with disc herniations and C7-T1 right-sided foraminal stenosis. There was loss of cervical lordosis at the upper levels. The patient underwent anterior cervical discectomy and fusion (ACDF) at the C4-5, C5-6, and C6-7 levels to treat mechanical neck pain and restore lordosis. In order to avoid an extra-level fusion and preserve motion, we performed a right-sided C7-T1 MPCF using a portable intraoperative computed tomography (iCT) scanner (Airo®; Brainlab AG, Feldkirchen, Germany), combined with 3D computer navigation to address the patient's radicular symptoms. Patient consent was obtained prior to performing the procedure.

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Minimally Invasive Laminotomy for Contralateral “Over-the-Top” Foraminal Decompression Using 3-Dimensional Total Navigation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz399 ◽

2019 ◽

Vol 19 (3) ◽

pp. E296-E296

Author(s):

Sertac Kirnaz ◽

Christoph Wipplinger ◽

Franziska Anna Schmidt ◽

R Nick Hernandez ◽

Ibrahim Hussain ◽

...

Keyword(s):

Minimally Invasive ◽

Facet Joint ◽

Computer Navigation ◽

3D Navigation ◽

Intraoperative Computed Tomography ◽

3 Dimensional ◽

Left Lower Extremity ◽

Patient Consent ◽

Foraminal Disc Herniation ◽

Over The Top

Abstract This video demonstrates the step-by-step surgical technique for the minimally invasive laminotomy for contralateral “over-the-top” foraminal decompression. This technique allows for excellent decompression with clearance of the contralateral recess and foramen. In the video, we present the case of a 51-yr-old female patient with a past medical history of left L5-S1 microdiscectomy who presented in clinic with residual/recurrent foraminal disc herniation at L5-S1 compressing the left L5 nerve root. The patient had left lower extremity pain in the left hip and thigh that radiated down the front and side of the leg, as well as tingling and numbness in the left foot. The patient was treated via a L5-S1 microdiscectomy using a portable intraoperative computed tomography scanner, (Airo®, Brainlab AG, Feldkirchen, Germany), combined with 3-dimensional (3D) computer navigation. Patient consent was obtained prior to performing the procedure. The main advantage of this technique is the direct “over-the-top” trajectory to the foraminal pathology that minimizes the need of facet joint resection. The use of 3D navigation facilitates surgical planning and further minimizes facet joint compromise. Particularly, the inferior facet contralateral to the approach side as well as its outer capsular surroundings can be preserved. Recent biomechanical studies have shown that “over-the-top” decompression produces significantly less instability than a traditional open midline laminectomy.

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Minimally Invasive Full-Endoscopic Posterior Cervical Foraminotomy Assisted by O-Arm-Based Navigation

January 2018 - Pain Physician ◽

10.36076/ppj.2018.3.e217 ◽

2018 ◽

Vol 1 (21;1) ◽

pp. E217-E223

Author(s):

Yue Zhou

Keyword(s):

Minimally Invasive ◽

Symptom Duration ◽

Foraminal Stenosis ◽

Arm Pain ◽

Sf 36 ◽

Posterior Cervical Foraminotomy ◽

Invasive Method ◽

Foraminal Disc Herniation ◽

Cervical Foraminotomy

Background: Navigated percutaneous endoscopic cervical discectomy (PECD) is a promising minimally invasive surgery for treating cervical spondylotic radiculopathy. PECD has been described as a safe, effective, and minimally invasive method for patients with radiculopathy, but it comes with a steep learning curve. Due to the limited field of vision, anatomic localization is difficult for surgeons until using the O-arm based navigation. In this study, patients with radiculopathy due to foraminal disc herniation or foraminal stenosis in the lower cervical spine underwent the single level full endoscopic posterior cervical foraminotomy procedure assisted by O-arm-based navigation. Objective: The purpose of this study was to evaluate the clinical, radiological outcome and the factors predicting an excellent outcome of patients who underwent full endoscopic posterior cervical foraminotomy procedure assisted by O-arm-based navigation. Study Design: A retrospective analysis of consecutively prospectively collected data. Setting: This study was conducted by a university-affiliated hospital in a major Chinese city. Methods: Forty-two patients who had single-level foraminal disc herniation or foraminal stenosis were retrospectively reviewed. Radicular arm pain was the most common presenting symptom in patients. All patients underwent full-endoscopic posterior cervical foraminotomy assisted by O-arm-based navigation. Clinical outcomes were assessed by the visual analog scale (VAS) for neck and radicular arm pain, neck disability index (NDI), and the short form-36 health survey questionnaire (SF-36) in the immediate preoperative period, immediately postoperative, and at the final follow-up. The clinical parameters and radiological parameters included cervical curvature (CA), segmental angle (SA), and range of motion (ROM), which were assessed preoperatively and at the last follow-up. Results: The mean follow-up for the patients was 15 months. There were no perioperative complications. The VAS score for radicular arm pain and neck pain and the NDI score improved significantly in all of the patients. The SF-36 score reflected significant improvement in all 8 domains. Excellent and good outcomes were achieved in 38 out of 42 patients. The cervical curvature range of motion (CA-ROM) statistically and significantly improved at the final follow-up period compared with the preoperative period. The SA was less kyphotic after PECD at the final follow-up. The postoperative CA and CA-ROM improved but did not significantly change. On the univariate analysis, patients with a symptom duration of less than 3 months had a better outcome than patients with a symptom duration of more than 3 months (excellent, 83.33% vs. 50.00%). Limitations: This was a retrospective study with medium follow-up outcomes (mean 15 months). Conclusions: The results of this study show that the full endoscopic posterior foraminotomy assisted by O-arm-based navigation is a safe and effective option for cervical radiculopathy, with the advantages of a minimally invasive method. Patients with symptom duration less than 3 months had a better outcome than patients with symptom duration more than 3 months. Key words: Minimally invasive, cervical foraminotomy, endoscopic, navigation, O-arm, percutaneous endoscopic cervical discectomy

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Minimally Invasive Transforaminal Lumbar Interbody Fusion using 3-Dimensional Total Navigation: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opz042 ◽

2019 ◽

Vol 18 (1) ◽

pp. E9-E10

Author(s):

Sertac Kirnaz ◽

Rodrigo Navarro-Ramirez ◽

Christoph Wipplinger ◽

Franziska Anna Schmidt ◽

Ibrahim Hussain ◽

...

Keyword(s):

Minimally Invasive ◽

Real Time ◽

Interbody Fusion ◽

Intraoperative Imaging ◽

Computer Navigation ◽

Transforaminal Lumbar Interbody Fusion ◽

Radicular Pain ◽

3D Navigation ◽

Patient Consent ◽

K Wires

Abstract This video demonstrates the workflow of a minimally invasive transforaminal interbody fusion (MIS-TLIF) using a portable intraoperative CT (iCT) scanner, (Airo®, Brainlab AG, Feldkirchen, Germany), combined with state-of-the-art total 3D computer navigation. The navigation is used not only for instrumentation but also for intraoperative planning throughout the procedure, inserting the cage, therefore, completely eliminating the need for fluoroscopy. In this video, we present a case of a 72-yr-old female patient with a history of lower back pain, right lower extremity radicular pain and weakness for 2 yr due to L4-L5 spondylolisthesis with instability and severe lumbar spinal stenosis. The patient is treated by a L4-L5 unilateral laminotomy for bilateral decompression (ULBD) and MIS-TLIF. MIS-TLIF using total 3D navigation significantly improves the workflow of the conventional TLIF procedure. The tailored access to the spine is translated into smaller but more efficient surgical corridors. This modification in a “total navigation” modality minimizes the staff radiation exposure to 0 by navigating in real time over iCT obtained images that can be acquired while the surgical staff is protected or outside the OR. Furthermore, this technique makes real-time and virtual intraoperative imaging of screws and their planned trajectory feasible. 3D Navigation eliminates the need for K-Wires, thus decreasing the risk of vascular penetration injury due to K-Wire malpositioning. 3D navigation can also predict the positioning of the interbody cage, thereby, decreasing the risk of malpositioning or subsidence. Patient consent was obtained prior to performing the procedure.

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Technique of Minimally Invasive Cervical Foraminotomy

Operative Neurosurgery ◽

10.1093/ons/opx053 ◽

2017 ◽

Vol 13 (6) ◽

pp. 693-701 ◽

Cited By ~ 2

Author(s):

Donald A Ross ◽

Kelly J Bridges

Keyword(s):

Minimally Invasive ◽

Specific Treatment ◽

Large Series ◽

Invasive Technique ◽

Foraminal Stenosis ◽

Posterior Cervical Foraminotomy ◽

Posterior Foraminotomy ◽

Invasive Techniques ◽

Cervical Foraminotomy ◽

Attention To Detail

Abstract BACKGROUND Posterior cervical foraminotomy is a long utilized and commonly performed procedure, but has been supplanted in many cases by anterior procedures. With the advent of minimally invasive techniques, posterior foraminotomy may again deserve a prominent place in the treatment of cervical foraminal stenosis. OBJECTIVE To report in detail a successfully utilized minimally invasive technique and the results in a large series of patients, by a single author. METHODS The technique is described and illustrated in detail. A retrospective review of the use of this technique in a large series is reported. RESULTS Precise details of the technique are described with specific attention to complication avoidance. In over 360 cases, there have been no nerve root injuries other than idiopathic C5 palsies, no wound infections, and a single durotomy that required no specific treatment. CONCLUSION Minimally invasive posterior cervical foraminotomy is a well-tolerated and effective procedure which can be performed with minimal complications when attention to detail is maintained.

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