Page 22 - Read Online

Ohmori et al. FPCF for bony stenosis

A B

C D E

Figure 3: (A) Interlaminar window and yellow ligament (*) are clearly seen; (B) inferior edge of C5 vertebral lamina is partially cut with a high-
speed drill; (C) superior edge of C6 vertebral lamina is also resected; (D) the yellow ligament is cut with scissors; (E) lateral edge of dura mater
and C6 nerve root (**) should be completely decompressed. Left side: cephalic; right side: caudal; upper side: medial; lower side: lateral
and yellow ligament were visible [Figure 3A]. First, the younger than that in group S (P < 0.05). The average
inferior edge of the C5 vertebral lamina was cut with operative time in group H was 97.2 ± 19.5 min,
a high-speed drill (NSK-Nakanishi, Kanuma, Japan) while that in group S was 102 ± 28.9 min. Only 2
[Figure 3B], and the superior edge of the C6 vertebral complications occurred, both in group H. One patient
lamina was cut [Figure 3C]. The yellow ligament was had increased radicular pain after surgery because the
cut and removed [Figure 3D], and the perineural nerve root was stimulated during epidural hemostasis.
membrane was carefully removed using a bipolar The second had a lower lamina fracture due to cutting
coagulator (Surgi-Max Plus, Trigger-flex System: with the high-speed drill. In this case, a small fracture
®
®
Elliquence, LCC, Baldwin, New York, USA) with output line on the C6 vertebral lamina was found in the coronal
power set to 20-25 watts. Next, the lateral edges of postoperative CT [Figure 4]. Fortunately, the patient
the dura mater and C6 nerve root were decompressed had no symptoms. The postoperative hospital stays in
[Figure 3E]. After complete decompression of the nerve group H and Y were 3.0 and 3.9 days, respectively.
root, irrigation was interrupted to reveal any bleeding. There were no significant differences in pre-operative
If observed, hemostasis was performed with a bipolar neck or arm pain between the groups (neck pain: group
coagulator. The wound was closed without drainage. H 51 ± 24.1, group S 40.1 ± 33.3; arm pain: group H
Ideally, all operations were performed while monitoring 60 ± 19.3, group S 58.3 ± 27.1). On average, the neck
the motor evoked potentials of the following muscles:
deltoid, brachioradialis, oppenens pollicis, tibialis Table 1: Basic data of groups H and S
anterior, and gastrocnemius. Patients began walking Group H Group H P
3 h after surgery. (n = 34) (n = 25)
Gender (M/F) 24/10 21/4 0.15
RESULTS Age (years) 50 (30-68) 59 (46-81) 0.01
C4/5 (n = 6 )
C4/5 (n = 4)
Gender, age, segment, and postoperative follow-up Operated C5/6 (n = 11) C5/6 (n = 14)
period are shown in Table 1. No significant differences spinal level C6/7 (n = 15) C6/7 (n = 7) 0.50
were observed between the groups in terms of gender, C7/T1 (n = 2)
segment, or postoperative follow-up period. However, Follow-up 311 339 0.55
the mean patient age in group H was significantly period (days)

Mini-invasive Surgery ¦ Volume 1 ¦ June 30, 2017 65