Full-Endoscopic Cervical Lamino-Foraminotomy and Cervical Laminectomy

Hello, everybody. Uh, it's a great honor for me to have a chance to have a talk in the first virtual conference, ESCON 2020. We're gonna talk about the endoscopic cervical laminar foraminotomy and the Cervical laminectomy procedures. This is my disclosure. My real disclosure with India is, uh, my fellows and my friends.

Doctor Yadu Aher Min Sagar Ashin Kutub Naveen, uh, hopefully, I'm looking forward to see you guys all soon. Please, uh, keep safe and keep connected.

My international fellows, they have published a lot of the SCCI high Quality of the paper MIS. So I really appreciate your contribution. So also the welcome to all the application of fellows from India. You can say that minimal invasive spinal Surgery in the cervical Spine.

Hopefully, the, we can classify the posterior and Anterior approach. There's a uh sort of the MIS procedure in the cervical posterior Approach, tubular prino and discectomy, and anteriorly, we have the conventional trans-uncle anterior priotomy discectomy, and a little bit modified technique transcopoal Approach, and also the transdiscal full endoscopic discectomy.

Today, I'd like to focus on the uh full endoscopic uh Approach, a couple of the cervical endoscopic procedure for radiculopathy and the myelopathy. Currently, I am working on the upcoming issue, and cervical endoscopic, uh, ULPD procedure for uh central.

Stenosis. So let me talk about the cons about the anterior cervical Approach. We have the little bit, the serious complication related to esophageal rupture and variation and the some sort of the implant failure, hoarseness, swallowing difficulties, etc. And this is the basic uh phasis in the procedure of the surgical endoscopic uh laminar foraminotomy. Uh, I'm gonna briefly introduce this kind of step.

First one, we need to prepare the instruments for the procedures, a walk channel endoscope instruments and radio frequency. Not only the scope is so, but also we have, we need to definitely need the radiofrequency for endoscopic uh cervical procedures. So all set of and patient positioning actually.

Same with the microscopic tubular or MED uh Approach and incision is also very similar with the microscopic tubular Approach, a little bit, uh, usually we have, we need to make incision 1 to 2 cm from the midline and the, using the secular uh sequential dilator.

We need to fix the tube and the index level and the sequential dilator and retractive placements like that. And then finally, usually we say the B point or Y point like that, laminotomy procedures using the drill and the small kerosene, the medial facet, the 50%, right? But even though the, we, we have made more than

Uh, have major vasectomy, usually it's gonna be OK, I think. Remove the soft tissue, the soft tiss, the soft disc condition there if, if present, uh, we, we need to remove the, uh, soft disc.

Before a discectomy, this is sensory nerve. Underneath the sensory, there is usually the motor fiber. This is not the conjoined nerve. This is usual normal finding of the uh cervical nerve. Adequate foraminotomy in case of spinal uh cervical foraminal stenosis.

Or even in the C5 disc. One of the pros of the full endoscopic Surgery, we have this kind of tip control, articulate and punch, rotating the scope to see the ventral side, uh, if the ventral side of facet. It, it is very nice to see the

A corner of the deeper portion of the father's joint.

Let's move on to the case, cervical foraminal stenosis. This patient was 52 years old female, right arm Pain. Patient also had a medical history of breast Cancer with the recurrence. She has been treated by the chemotherapy and radio, radiotherapy, etc. Also, the, she had a history of lumbar fusion profile level and some

Sometimes a dynamic MRI is a very useful tool for identifying the real Pathology right there. We have the various kinds of option. The anterior cervical discectomy fusion is one of the common and popular ones, and artificial disc replacement. Once you have narrowed down the option with the endos MIIC compression, there are sort of tworos of compression.

A microscopic and the tubular MED and open and endoscopic decompressssion like that. Of course, I did the endoscopic posterior surgical foraminotomy, PECF this patient.

I'd like to highlight the motion. Motion is well preserved by this endoscopic Surgery. I followed this patient more than 4 years.

Right? Also, the natural, the disc height, and there's a little bit the slowly progression of the disc desiccation. It looks like the natural, uh, progression. What about the clinical outcome and I score?

And the NDI school, the NDI school nearly approached to reach out to the white person. It's actually near to normal. This is a very interesting case, endoscopic cervical disc active for huge foraminal disc herniation. He complains of arm Pain, but he had also the both hand weakness and headache, and a little bit mild weakness of both legs.

You can figure out the huge cannot compromise disc connection. Also the moderate spinal stenosis there, and the diagnosis was the huge disc connection, a migraine disconnection and also the tandem OLF and moderate central stenosis. We can narrow down option the compression.

And then we can have a choice for endoscopic decompress and this character. At the time, a fellow from Saudi, he was so for surprise. My God, they want to do the endoscope for this huge it's nonsense, crazy.

Anyway, I did the endoscopic discectomy procedures. Initially, laminotomy. The one of the key essential to make the enough loom, enough laminotomy, that's going to be key surgical procedures for safety issue. And then the discectomy could be done simply manner with the simple.

The same with the Other lumbar disc interlaminar discectomy. There are a lot of pieces of the rupture fragment there. Yeah, you can see the post-op MRI. This is pre-op mass and also there's a central stenosis over the central and stenosis, but central stenosis and also the ruptured disc. Regarding the muscle, there's a little interval change as well. This is one year followup X-ray.

No instability. Patient has been very happy for uh this kind of MIS endoscopic Surgery. I'd like to say the cervical endoscopic ULVD for centralized stenosis for patients usually have myelopathy and cardparesis, cardioplegic or etc. Let's move on the case. 64 years female patient, neck Pain in both arms with numbness and tingling sensation.

Also have the weakness in both arms, right? So this is neurologic examination and x-ray. No definite install in X-ray, but patient have the little bit weakness on upper arm side, and this is MRI. MRI shows us the disc protrusion centrally.

And the, there's also the foraminalysis in both sides, the 5/6 level, and the, there is a, also the call signal change in cytal T2 MRI.

That is a sign of myelopathy as well. This is the city and the HLME is 6.7. The main problem, of course of 5/6 is the same problem. So we have the very kind of option to level off the HCTFcorpectomy, and posterior decompression laminoplasty or the lateral miss fusion. We have the option for that. Initially, I had done the

Uh, two-level ACDF Surgery for the patient, and the outcome was a partial improvement, no intra complication.

And the ambulation, ambulation was possible with the support, uh, but weakness is partial improvement, but there, there's still laminant weakness on arm and leg side. And this is post MRI. You can figure out there's a little bit uh remain, central and the fronaminal stenosis at the 56 level. So we have the option in this situation, wait and see and continue the medication with a steroid.

And additional posterior decompression. And if you want to do the posterior additional decompression, I'd like to do the MIS decompression, especially for the, with the endoscope. This is usual post-operation room setup and the positioning. So in this patient, I put the patient head under her shoe headset, not the male field fixation. Intrafluoroscope image to find

To check the ideal location of the, for the cervical ULBD like that is bullet point, right?

The Pain and the seizure has gone already. Post-op x-ray.

So I checked the CT and the MRI again. Well, the perfect the compression of the central canal and the foramen, right?

This is the, uh, another case of the cervical endoscopic ULBD in quadrimparsis, parsis uh close to plagic status.

I had done the HCTF profile level before, 6 or 88 years back.

Uh, this is the, uh, central stenosis. It's one of the junctional problem. This is another case of the, uh, acute progressing paraplegic that is with the hemorrhagic.

Uh, what I said at the C71 junction.

Because C71 junction is, is not the visible when, when the patient had the position of prone because of the Shoulder, it hinders the exact location, uh, endoscope. That's why the navigation gonna be safer and the essential tool to identify the role, location of the endoscope. Because there's no, the bleeding.

And we don't have to put the drain, much improved, so the tranquilization allodynia has gone immediately after Surgery. So full endoscopic spinal Surgery and cervical Spine, it is very nice tool for discectomy and the cervical foraminotomy. It has.

Uh, a sort of the proven data article for the treatment of unilateral cervical radiculopathy. Endoscopy, ULVD, uh, the, the evidence doesn't reach out by the recommendation, but the technically feasible, I think the more and more evidence will

be coming up soon. So currently, most indication of MIS microscopic Spine Surgery are rapidly replaced by Full-endoscopic Spine Surgery in cervical radiculopathy and myelopathy. The first indication of discal prolapse and placental foraminal discal stenosis, it could be treated well.

Endoscopic, cervical foraminotomy, and a discectomy, but the central stenosis, some kind of the myelopathy also could be treated by the endoscopic procedures.

Thank you.