Original Article

Microendoscopic Decompression Procedure for Cervical Radiculopathy and Myelopathy: A Prospective Comparative Study Between Conventional Expansive Laminoplasty and Microendoscopic Laminotomy for Cervical Myelopathy

A Minamide, M Yoshida

Citation

A Minamide, M Yoshida. Microendoscopic Decompression Procedure for Cervical Radiculopathy and Myelopathy: A Prospective Comparative Study Between Conventional Expansive Laminoplasty and Microendoscopic Laminotomy for Cervical Myelopathy. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 2.

Abstract

Recently, surgical strategies for expansive laminoplasty in cases of cervical spondylotic myelopathy have been developed. For instance, when axial symptoms following expansive laminoplasty have been reported the frequency is said to be three times that of cervical anterior interbody fusion. The invasion of cervical posterior soft tissues including muscles and ligaments has been considered to play major roles in causing axial symptoms. To alleviate these problems, we are applying microendoscopic laminoplasty (MEL) as a minimally invasive strategy for cervical decompression surgery. We are expanding the application of this technique from lumbar spine to cervical spine. The microendoscopic method is developing as an effective technique for bilateral decompression surgery that uses a unilateral approach. First, hemilaminectomy is performed. Then laminotomy on the contralateral side should be conducted. Finally, lamioplasty can be completed to enlarge the spinal canal. The aims of this study were to clarify whether the MEL technique is a likely candidate to become a new surgical method for cervical myelopathy as well as to evaluate the clinical outcomes including axial symptoms for MEL surgery.

Materials and methods: Forty-four patients with cervical spondylotic myelopathy were selected. There were 25 males and 19 females, and the mean age was 63 years old. This is a prospective comparative study between conventional expansive laminoplasty and microendoscopic laminoplasty for cervical myelopathy. All patients received either conventional or microendoscopic laminoplasty. The mean follow-up period was 14 months. The following items were evaluated for each surgical method. They were graded under the neurological evaluation system of the Japanese Orthopedic Association scoring system (JOA score), recovery rates of JOA score, visual analog scale (VAS) for assessment of treatment of axial symptoms, Short Form 36, blood loss, the change of C reactive protein levels (CRP) and the mean hospital stay, postoperatively.

Results: The mean recovery rate was respectively 51% for the conventional group, and 53% for the microendoscopic group. There were no significant differences between the groups. The VAS for axial symptoms was 3.2 for the conventional group and 1.1 for microendoscopic group. The VAS scale in the microendoscopic group was significantly lower than that in conventional group. As for the SF-36, the scores for both role emotion and social functioning in the microendoscopic group were found to be significantly higher than those of the conventional group. The amount of blood loss in the microendoscopic group was a quarter of that of the conventional group. The mean period for hospital stay was 9.8 days for the microendoscopic group. This figure was half of that found for the conventional group. The change of CRP levels for the microendoscopic group was also significantly lower than that found for the conventional group.

Conclusion: The microendoscopic laminoplasty group had clinical outcomes that were equal to, or had surpassed those of conventional laminoplasty. The minimally invasive technique of microendoscopic laminoplasty clearly decreased the development of axial symptoms, largely due to producing less damage to cervical soft tissues. Furthermore, microendoscopic surgery allowed patients to return to their normal daily routine more quickly.

 

References

Author Information

A. Minamide, Dr.med.
Dept of Orthopaedic Surgery, Wakayama University

M. Yoshida, Dr. med.
Professor, Dept of Orthopaedic Surgery, Wakayama University

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