Page 16 - Read Online

Nishimura Percutaneous endoscopic cervical laminectomy

from 10.9 ± 0.7 to 14.3 ± 1.3 (P = 0.0000002). The Authors’ contributions
mean recovery rate was 56.6 ± 17.6%. The mean Y. Nishimura contributed solely to the paper.
operation time was 87.1 min (range 70-141 min), and
neitherintra- nor postoperative complications were Financial support and sponsorship
observed. The mean hospital stay was 5.7 days (range
3-8 days), and all patients were discharged. None.

A representative case (case 3) is shown in Figure 1. A Conflicts of interest
67-year-old man complained of progressive worsening There are no conflicts of interest.
of numbness of both upper extremities and impairment
of skillful movementand walking. A neurological Patient consent
examination revealed an increase in all tendon Informed consent was obtained from the patients
reflexes, moderate muscle weakness (grasp strength: for publication of this study and any accompanying
right, 18 kg; left, 27 kg), and a sensory disturbance. images.
Sagittal cervical magnetic resonance imaging (MRI)
revealed central canal stenosis at the C5/6 and C6/7 Ethics approval
intervertebral disc levels [Figure 1A-C]. PECL was This study was approved by the ethics committee of
performed, and all symptoms improved to some extent the Wakayama KOYO Hospital and the procedures
(grasp strength: right, 24 kg; left, 29 kg) 4 weeks were in accordance with the ethical standards of the
after PECL. Postoperative MRI revealed enlargement committee and with the Helsinki Declaration.
of the corresponding spinal canal [Figure 1F-H]. A
comparison of preoperative [Figure 1D and E] and REFERENCES
postoperative [Figure 1I and J] computed tomography
findings demonstrates the extent of the laminectomy 1. Ito M, Nagahama K. Laminoplasty for cervical myelopathy. Global
(arrows). Spine J 2012;2:187-94.
2. Duetzmann S, Cole T, Ratliff JK. Cervical laminoplasty developments
DISCUSSION and trends, 2003-2013: a systematic review. J Neurosurg Spine
2015;23:24-34.
PECL is a surgical technique that can be used to 3. Ruetten S, Komp M, Merk H, Godolias G. Full-endoscopic cervical
enlarge and shape a narrowed spinal canal without posterior foraminotomy for the operation of lateral disc herniations
using 5.9-mm endoscopes: a prospective, randomized, controlled
destroying the spinal structure and supporting study. Spine (Phila Pa 1976) 2008;33:940-8.
elements more than conventional microscopic 4. Nakagawa Y, Yoshida M, Yamada H. Perioperative complications
laminoplasty, namely cervical micro endoscopic associated with cervical microendoscopic laminoplasty (CMEL) for
laminectomy. [12-15] However, the technique does have cervical myelopathy patients. Society for Minimally Invasive Spine
some disadvantages and requires a drill to be used in Surgery (SMSS); 2012.
a surgical field of approximate 1 cm and resection of 5. Tonosu J, Oshima Y, Shiboi R, Hayashi A, Takano Y, Inanami H,
3
the yellow ligaments is performed via this small bone Koga H. Consideration of proper operative route for interlaminar
approach for percutaneous endoscopic lumbar discectomy. J Spine
window. Therefore, this operation takes a lot of time and Surg 2016;2:281-8.
causes some operator fatigue. It is recommended that 6. Adamson TE. Microendoscopic posterior cervical
PECL should be carefully performed by the surgeon laminoforaminotomy for unilateral radiculopathy: results of a new
using a sufficient endoscopic technique. In this study, technique in 100 cases. J Neurosurg 2001;95:51-7.
case 3 was the only case involving multilevel stenosis. 7. Yabuki S, Kikuchi S. Endoscopic surgery for cervical myelopathy
The operation time was 141 min and is significantly due to calcification of the ligamentum flavum. J Spinal Disord Tech
2008;21:518-23.
longer than surgeries involving single level stenosis 8. Nakagawa Y. Cervical microendoscopic laminoplasty for cervical
(mean operation time is 81.7 min). Therefore, it is myelopathy. Spine Spinal Cord 2015;28:799-807.
also recommended that PECL should currently be 9. Nishimura Y, Lubbers T. Perkutane endoskopische dorsale HWS-
performed only for single level stenosis. Dekompression. Wirbelsaule interdisziplinar, Schattauer; 2017. p.
424-6.
In conclusion, the current study has reported on the 10. Hirabayashi K, Miyakawa J, Satomi K, Maruyama T, Wakano K.
experience of surgeon in this department with PECL, Operative results and postoperative progression of ossification among
a minimally invasive cervical posterior decompression patients with ossification of cervical posterior longitudinal ligament.
Spine (Phila Pa 1976) 1981;6:354-64.
surgical technique. This is a useful procedure, 11. Hirabayashi K, Watanabe K, Wakano K, Suzuki N, Satomi K, Ishii
although it is a surgery that surgeons with sufficient Y. Expansive open-door laminoplasty for cervical spinal stenotic
endoscopic technique must perform carefully under myelopathy. Spine (Phila Pa 1976) 1983;8:693-9.
strict indication. 12. Oshima Y, Takeshita K, Inanami H, Takano Y, Koga H, Iwahori
72 Mini-invasive Surgery ¦ Volume 1 ¦ June 30, 2017