gms | German Medical Science

Objective: Cervical spondylotic myelopathy is a multifactorial disease that is directly influenced by the degree of spinal stenosis. Surgery remains the best therapy. A posterior approach is recommended in patients with multilevel cervical compression. Several technical modifications of this procedure have been developed. Aim of this experimental study was to evaluate technique and results of a fully endoscopic arcocristectomy in a cadaver study.

Methods: We performed fully endoscopic arcocristectomy on ten formalin-fixed human cervical specimens. Depending on the specimen, a decompression from C3 to Th1 was performed. We used a full endoscopic system manufactured by Wolf^TM. The 165 mm x 6.9 mm endoscope with a 25° optic enabled preparation in a 4.1 mm thick continuously rinsed rod. The decompression was performed with an endoscopic high-speed drill combined with the use of a special cutter. Fluroscopy served as intra-operative navigation. Before and after decompression we obtained high-resolution CT data to evaluate the diameter of the spinal motion segment.

Results: Overall, surgery was performed on 49 segments in ten specimens. A mean increase of 4,3 mm (±2,2 mm) in the sagittal diameter of the spinal canal was achieved. The maximum mean increase was 6,2 mm (±3,3 mm) in the level C6/7 and 5,2 mm (±1,2 mm) in C5/6. To decompress five segments, two independent skin incisions measuring each about 1 cm were necessary for the surgical approach. For one segment decompression an average operating time of 26 minutes (±9 min) was necessary.

Conclusions: The fully endoscopic arcrocristectomy is feasible and achieves a sufficient decompression of the spinal canal as detected by CT. This minimally invasive technique protects most of the dorsal structures in the cervical spine and therefore probably preserves biomechanical functions which has to be proven in future studies.