Endoscopic decompression of cervical spondylotic myelopathy using posterior approach

Cervical spondylotic myelopathy, radiculopathy and myeloradiculopathy can be managed by laminoforaminotomy, or bilateral decompression using posterior approach in single or multilevel compression. Posterior endoscopic techniques allow preservation of motion segment and neural decompression without fusion.

A prospective study of 50 patients of cervical compressive myelopathy with primarily posterior lesion or multilevel anterior compression with acceptable preoperative lordosis was undertaken. Any instability, significant anterior compression, and cervical myelopathy secondary to tumor, trauma, severe ossification of posterior longitudinal ligament, rheumatoid arthritis, pyogenic spondylitis, and destructive spondylo-arthropathy were excluded from the study. There were 5, 23, 12, 10 patients with 2, 3, 4, 5 vertebral body level pathologies, respectively.

There were 2, 4, 7, 32, and 5 patients in preoperative Nurick grade 0, 1, 2, 3, and 4, respectively with an average of 2.6 grades. All the patients improved in post-operative grading with 10, 34, and 6 patients in 0, 1, and 2 grades (average 0.92), respectively. Better outcome was observed in patients with good preoperative grade and in short segment compression on cord. There was no change in cervical Cobb angle after surgery. Follow-up ranged from 6 to 24 months (averages 19 months). There was small dural tear, minor bleeding from muscles or epidural vessels and temporary C 5 root injury in 1, 3, and 2 patients, respectively.

Endoscopic decompression of cervical spondylotic myelopathy is a safe and an effective alternative treatment option in selected patients when pathologic changes are primarily posterior or multi level anterior lesions with acceptable preoperative lordosis.