Artikel
A minimally invasive posterior approach for the treatment of cervical radiculopathy and myelopathy. Surgical technique and preliminary results
Ein minimal invasiver dorsaler Zugang zur Behandlung von zervikalen Radikulopathien und Myelopathien. Chirurgische Technik und vorläufige Ergebnisse
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Autoren
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R. Greiner-Perth
- Klinik für Wirbelsäulenchirurgie, orthopädische Chirurgie und Neurotraumatologie, SRH Waldklinikum Gera
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Y. Allam
- Klinik für Wirbelsäulenchirurgie, orthopädische Chirurgie und Neurotraumatologie, SRH Waldklinikum Gera
| Veröffentlicht: | 8. Mai 2006 |
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Gliederung
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Objective: Degenerative cervical disorders predominantely lead to anterior spinal cord compression, which may be central and/or foraminal. To a smaller percentage, there is encroachment of the canal mainly from posterior by bulging yellow ligaments or bony appositions, resulting in compression syndromes of roots or spinal cord. The aim of this work is to present a minimally invasive posterior approach avoiding detachment of muscles for the treatment of cervical radiculopathy and myelopathy.
Methods: 13 patients suffering from cervical radiculopathy (4 patients) and myelopathy (9 patients) were operated according to this technique. In principle, this technique secures access to the diseased spinal segment via a percutaneously placed working channel (11 mm outer diameter and 9 mm inner diameter). The cervical paraspinal muscles are not deflected, but just spread between their fibres by special dilators. All further steps are performed through this channel under control of 3-dimensional vision through the operating microscope. The mean follow-up period was 17 months (one patient died after 9 months postoperative), and patients were evaluated using a modified version of Oswestry Index, called the Neck Disability Index (NDI) and the Visual Analogue Scale (VAS) for neck and arm pain.
Results: The mean NDI (P<0.0001) improved from 13.2 (pre-operative) to 4.8 (post-operative). The VAS for arm pain (P<0.001) and for neck pain (P<0.001) showed also marked post-operative improvement. Complete recovery of the pre-operative neurological deficit was found in 4 patients while the remaining 8 patients showed improvement of the neurological symptoms during the follow-up period. There were no intra-operative or post-operative complications and no re-operation.
Conclusions: The preliminary experience with this technique and the good clinical outcome, seems to promise, that this minimal invasive technique is a valid alternative to the conventional open exposure for treatment of lateral disc prolapses, foraminal bony stenosis and central posterior ligamentous stenosis of the cervical spine.
