A Comparative Study on the Minimal Invasiveness of Full-Endoscopic and Microendoscopic Cervical Foraminotomy Using Intraoperative Motor Evoked Potential Monitoring

Background and Objectives: Full-endoscopic cervical foraminotomy (FECF) and microendoscopic cervical foraminotomy (MECF) are effective surgeries for cervical radiculopathy and are considered minimally invasive in terms of damage to paraspinal soft tissue. However, no studies have quantitatively compared FECF and MECF in terms of neurological invasiveness. The aim of this study was to compare the neurological invasiveness of FECF and MECF using intraoperative motor evoked potential (MEP) monitoring. Materials and Methods: A chart review was conducted of 224 patients with cervical radiculopathy who underwent FECF or MECF between April 2014 and March 2020. Patients were 37 women and 187 men, with a mean age of 51 (range, 21–86) years. FECF was performed in 143 cases and MECF was performed in 81 cases. Results: Average MEP amplitude significantly increased from 292 mV before to 677 mV after nerve root decompression in patients who underwent the FECF. The average improvement rate was 273%. In patients who underwent the MECF, average MEP amplitude significantly increased from 306 mV before to 432 mV after nerve root decompression. The average improvement rate was 130%. The improvement rate was significantly higher for FECF compared with MECF. Conclusions: MEP amplitude increased after nerve root decompression in both FECF and MECF, but the improvement rate was higher in FECF. These results suggest that FECF might be more minimally invasive than MECF in terms of neurological aspects.

Anterior or posterior approach in the surgical treatment of cervical radiculopathy; neurosurgeons’ preference in the Netherlands.

Background For cervical foraminal nerve root decompression, anterior cervical discectomy with fusion (ACDF) or posterior cervical foraminotomy (PCF) can be applied. Amongst neurosurgeons, there seems to be a tendency to prefer ACDF over PCF, even though there are some advantages in favor of PCF. The object of present study is to evaluate which factors determine the choice for an anterior or posterior surgical approach in patients with a cervical radicular syndrome based on foraminal pathology. Methods A web-based survey was sent to all 133 neurosurgeons in the Netherlands. The first part focused on general perceived (dis)advantages of ACDF and PCF. The second part concerned questions about the choice between the two procedures. Furthermore, it was analyzed if exposure during training, amount of performed surgeries, assumed reoperation and complication rates influenced the choice of procedure by conducting Chi-square tests with post-hoc analysis. Results A total of 56 neurosurgeons responded (42%). Of these, 77% performed more than 10 ACDF and 25% more than 10 PCF annually. An overall preference for ACDF was observed, even when differentiating for a pure disc prolapse, a spondylotic or a combined stenosis. The most relative important factors for motivating the preference for either ACDF or PCF were: the assumed best decompression of the nerve root (18%), perceived congruence with current literature (16%), exposure during residency (12%), personal comfort with the procedure (11%), and experience with the technique (11%). Conclusions In this survey, there was an overall preference for ACDF above PCF for the surgical treatment of a foraminal cervical radiculopathy. In addition to subjective factors as “experience” and “ comfort” with the procedure, the respondents often motivated their choice as “the best one according to literature”. As there is currently no evidence about the superiority of any of the procedures in literature, this assumption is remarkable.

Surgical management of metastatic tumors of the cervical spine

ABSTRACT OBJECTIVE: To present the results from the clinical presentation, the imaging diagnostics, surgery and postoperative status of 17 patients with cervical spine metastases, to analyse all data and make the respective conclusions and compare them with the available data in the literature. PATIENTS AND METHODS: The study analysed data obtained by patients with metastatic cervical tumours treated in St George University Hospital over a period of seven years. All patients underwent diagnostic imaging tests which included, separately or in combination, cervical x-rays, computed tomography scan and magnetic-resonance imaging. Severity of neurological damage and its pre- and postoperative state was graded according to the Frankel Scale. For staging and operating performance we used the Tomita scale and Harrington classification. RESULTS: Seven patients had only one affected vertebra, 4 patients - two vertebrae, one patient - three vertebrae, 2 patients - four vertebrae, and in the other 3 patients more than one segment was affected. Surgery was performed in 12 patients. One level anterior corpectomy was performed in 6 patients, three patients had two-level surgery, and one patient - three-level corpectomy; in the remaining 2 cases we used posterior approach in surgery. Complete corpectomy was performed in 4 patients, subtotal corpectomy was used in 6 patients and partial - in 2 patients. Anterior stabilization system ADD plus® (Ulrich GmbH & Co. KG, Ulm, Germany) was implanted in 2 patients; in 8 patients anterior titanium plate and bone graft were used, and in 1 patient - posterior cervical stabilization system. CONCLUSIONS: Because of the pronounced pain syndrome and frequent neurological lesions as a result of the cervical spine metastases use of surgery is justified. The main purpose is to maximize tumor resection, achieve optimal spinal cord and nerve root decompression and stabilize the affected segment.

Minimally invasive palliative resection of lumbar epidural metastasis

Spinal metastatic lesions are the most common tumors encountered by spinal surgeons. As with procedures for degenerative disease, minimally invsive surgery techniques have been applied to minimize muscle and soft tissue destruction in procedures for tumor resection. Here, we present a 23-year-old female with radiculopathy and foot drop secondary to nerve root compression by epidural metastases from Ewing's sarcoma.This patient had a history of previous resection and instrumentation as well as multiple rounds of chemotherapy and radiation that failed to control her disease. The patient presented with three weeks of radicular pain and foot drop that was continuing to worsen at the time of her operation. The decision was therefore made to perform a palliative resection and decompression for relief of her progressive symptoms. In this video, we demonstrate a palliative tumor debulking and nerve root decompression utilizing an MIS approach.The video can be found here: http://youtu.be/tq4kbvKTebI.