Biportal endoscopic multisegment decompression laminectomy for cervical spondylotic myelopathy

Area of Science:

• Neurosurgery
• Orthopedic Surgery
• Minimally Invasive Spine Surgery

Background:

• Multilevel cervical spondylotic myelopathy (CSM) is a degenerative spinal condition causing neurological deficits.
• Traditional surgical approaches for CSM can be invasive with significant morbidity.

Purpose of the Study:

• To introduce and evaluate a modified biportal endoscopic technique for treating multilevel CSM.
• To assess the midterm clinical and radiological outcomes of this novel surgical approach.

Main Methods:

• A modified biportal endoscopic decompression laminectomy using the spinous process floating technique was performed on ten patients with multilevel CSM.
• Radiographic parameters (Cobb angle, range of motion, dural sac CSA, extensor muscle CSA) and clinical scores (VAS, JOA) were assessed preoperatively and postoperatively.
• Complications were meticulously documented.

Main Results:

• Significant improvements were observed in VAS neck and arm pain scores, and JOA scores (p < 0.05).
• The biportal endoscopic technique led to sustained dural sac cross-sectional area expansion (54.6% increase at 1 year).
• Delayed stress fractures of the spinous process occurred in 3-segment operations, with minimal reduction in extensor muscle CSA.

Conclusions:

• Biportal endoscopic posterior cervical laminectomy is a safe and effective treatment for multilevel CSM.
• This minimally invasive technique provides significant clinical improvement and central canal expansion.
• The modified biportal endoscopic approach represents a viable alternative to traditional open surgeries for CSM.