Ten-Step Minimally Invasive Cervical Decompression via Unilateral Tubular Laminotomy: Technical Note and Early Clinical Experience

• Published in: Operative neurosurgery (Hagerstown, Md.) Vol. 18; no. 3; pp. 284 - 294
• Main Authors: Hernandez, Robert Nick, Wipplinger, Christoph, Navarro-Ramirez, Rodrigo, Soriano-Solis, Sergio, Kirnaz, Sertac, Hussain, Ibrahim, Schmidt, Franziska Anna, Soriano-Sánchez, José-Antonio, Härtl, Roger
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 01-03-2020; Wolters Kluwer Health, Inc
• Subjects: Back surgery; Neurosurgery; Spine; Surgeons; Surgical apparatus & instruments; Surgical techniques; Technical report; Unilateral laminotomy for bilateral decompression; Cervical laminotomy; Cervical laminectomy; Tubular retractor; Cervical spondylotic myelopathy; ULBD; Minimally invasive spine surgery
• ISSN: 2332-4252; 2332-4260
• DOI: 10.1093/ons/opz156

Abstract
BACKGROUND
Minimally invasive techniques utilizing tubular retractors have become an increasingly popular approach to the spinal column. The concept of a unilateral laminotomy for bilateral decompression (ULBD), first applied in the lumbar spine, has recently been applied to the cervical spine for the treatment of cervical spondylotic myelopathy (CSM). A better understanding of the indications and surgical techniques is required to effectively educate surgeons on how to appropriately and safely perform tubular cervical laminotomy via ULBD.
OBJECTIVE
To describe a 10-step technique for minimally invasive cervical laminotomy and report our early clinical experience.
METHODS
A retrospective review identified 15 patients with CSM who were treated with this procedure. Visual analogue scale (VAS), neck disability index (NDI), and modified Japanese Orthopaedic Association (mJOA) scores were obtained pre- and postoperatively.
RESULTS
The mean age of the 15 patients was 73.1 ± 6.8 yr. The median number of levels treated was 1 (range 1-3). Mean operative time was 125.3 ± 30.8 or 81.7 ± 19.2 min per level. Mean estimated blood loss was 57.3 ± 24.6 cc. Median postoperative hospital length of stay was 36 h. No complications were encountered. Median follow-up was 18 mo. Mean pre- and postoperative VAS were 6.4 ± 2.4 and 1.0 ± 0.8, respectively (P < .001). Mean pre- and postoperative NDI were 46.4 ± 19.2 and 7.0 ± 6.9, respectively (P < .001). Mean pre- and postoperative Mjoa were 11.3 ± 2.5 and 14.5 ± 0.5, respectively (P < .001).
CONCLUSION
In our early clinical experience, minimally invasive cervical ULBD is safe and effective. Adherence to the presented 10-step technique will allow surgeons to safely address bilateral cervical pathology while avoiding complications.