Minimally Invasive Microscopic Posterior Cervical Decompression: Simple, Safe, and Effective

Pierluigi Vergara
Journal of Neurological Surgery. Part A, Central European Neurosurgery 2017, 78 (5): 440-445
Background and Study Aims  Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the elderly population. Surgery is usually successful in preventing any deterioration, as well as improving functional status and quality of life. This study assesses the safety and efficacy of minimally invasive microscopic posterior cervical decompression for the treatment of CSM. Materials and Methods  A retrospective review of patients with myelopathy from cervical stenosis treated with minimally invasive posterior cervical decompression was performed. The operation was performed through a nonexpandable tubular retractor and operating microscope. Results  Twelve patients were identified. There were no early or late complications. Average age was 74.5 years. Three patients were > 80 years of age and tolerated the operation extremely well. Three cases were two-level decompressions; nine were single level. Eight patients were operated on as elective cases, with average postoperative length of stay of 0.9 days. Average surgical time was 77.5 minutes per level. Postoperative neck pain was minimal (1.5/10). All patients improved postoperatively, particularly those who started with severe deficits. In fact, five patients were unable to walk preoperatively and were wheelchair- or bed-bound, and they returned to walking within weeks. The modified Japanese Orthopedic Association score improved from 8.4 (range: 4-14) to 13.5 (range: 10-15); the Nurick score changed from 3.8 (range: 2-5) to 2.3 (range: 1-4). Conclusions  Minimally invasive microscopic posterior cervical decompression is a safe and effective treatment for CSM in selected cases. Our initial experience highlights the potential benefits of this relatively new technique.

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