Endoscopically Assisted Minimally Invasive Laminoplasty in The Treatment of Cervical Spondylotic Myelopathy

The authors present a case of cervical myelopathy due to degenerative stenosis of the spinal canal. They employed an endoscope to aid in the improved visualization during the release of ligamentous attachments between the cervical dural sac and the ventral aspect of the cervical lamina during laminoplasty. The patient had two paraspinal 2 cm incisions through which a MED tubular retractor was placed, and most of the bony decompression was done using an operating microscope. The lamina was detached from the lateral masses with a high-speed drill. The bony cuts in this lateral groove were completed with Kerrison rongeurs. Silk stitches were passed through the spinous processes to elevate the cervical laminae from the dural sac and create the posterior expansion of the cord's space. This bilateral laminoplasty was then secured with mini-titanium plates. The authors present their utilization of the spinal endoscope in improved visualization of the surgical dissection, which can be problematic even with an operating microscope through the small exposure afforded by the MED tubular retractor system. The illumination and magnification helped safely execute this hybrid operation that employed two different minimally invasive spinal surgery technologies, including the operating microscope and a spinal endoscope. In the authors' opinion, such hybridizations may be the stepping stone towards nextgeneration advances in the cervical spine's minimally invasive surgery.

Keywords: Cervical spondylotic myelopathy, Endoscopy, Laminoplasty.