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Unilateral biportal endoscopic laminectomy with lateral mass screw fixation for treating cervical spinal stenosis

  • How I Do it - Spine degenerative
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Abstract

Background

The unilateral biportal endoscopic (UBE) technique is less invasive and has a faster recovery time than open surgery. Compared with the uniportal technique, the biportal technique has a larger field of vision and a wider operation range.

Method

We attempted the posterior UBE approach for cervical stenosis at the C4–C6 levels. UBE decompression of C4–C6 with unilateral lateral mass screw fixation at the C4–C5 levels was performed under general anesthesia.

Conclusions

We successfully performed cord decompression at the C4–C6 levels using the UBE technique. This approach could be used as an alternative method to treat cervical stenosis with instability.

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References

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Funding

This work was supported by the National Key R&D Program of China (2019YFC0121400).

This study protocol was approved by the Research Ethics board in our hospital. The patient signed a written informed consent form that she will be enrolled in this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedics, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China

    Chengyue Zhu, Hao Pan & Wei Zhang

  2. Nursing Department of Operating Room, Hangzhou Traditional Chinese Medicine Hospital Affiliated to Zhejiang Chinese Medical University, Tiyuchang Road No. 453, Hangzhou, 310007, China

    Xueqing Deng

Authors
  1. Chengyue Zhu
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  2. Xueqing Deng
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  3. Hao Pan
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  4. Wei Zhang
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Corresponding author

Correspondence to Wei Zhang.

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Conflict of interest

The authors declare no competing interests.

Additional information

Key points

• We successfully performed total laminectomy for cervical stenosis with unilateral lateral mass screw fixation using a biportal endoscopic posterior approach.

• The benefits of the endoscopic approach included the preservation of the paraspinal muscles and ligaments, a minimal amount of estimated blood loss, fast postoperative recovery, and a short hospital stay.

• The portals were designed based on the lesion site, and the endoscopic instruments moved across the surface of the lamina; thus, two incisions were sufficient for multilevel decompression.

• Imaging data should be analyzed meticulously, and the course of the vertebral artery and any aberrant anatomy should be recognized.

• Dissection should not exceed the lateral margin of the lateral mass; otherwise, significant bleeding can occur, obscuring the operation field.

• A 2-mm diamond burr can be used to locate the screw entry points under fluoroscopy.

• It is slightly difficult to insert the rod into the polyaxial screws under endoscopy, and more patience is needed.

• The locking nuts can be implanted with the aid of a hemi-cannula to ensure that the locking nuts are not lost in soft tissue.

• Unilateral and bilateral lateral mass screw fixation can produce similar results in terms of cervical curvature maintenance and clinical outcomes [3].

• The dorsal cortex of the lamina can be removed with a grinding drill, and the ventral cortical bone can be carefully removed with a 1-mm Kerrison rongeur to ensure that the cord is not injured.

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Zhu, C., Deng, X., Pan, H. et al. Unilateral biportal endoscopic laminectomy with lateral mass screw fixation for treating cervical spinal stenosis. Acta Neurochir 164, 1529–1533 (2022). https://doi.org/10.1007/s00701-022-05212-y

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  • DOI: https://doi.org/10.1007/s00701-022-05212-y

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