Posterior Cervical Percutaneous Endoscopic Ventral Bony Decompression

Abstract

Recent literature has established the noninferiority and superiority of various endoscopic procedures for cervical decompression relative to open surgeries. Foraminal stenosis, lateral disc herniations, and central canal stenosis are pathologies, which can be treated with posterior endoscopic procedures such as “posterior endoscopic cervical foraminotomy,” “posterior endoscopic cervical discectomy,” and “cervical endoscopic unilateral laminotomy for bilateral decompression.” Ventral bony compression is a pathology, which is more challenging to treat through these posterior approaches. Its ventral location makes operative access difficult through posterior approaches, and the consistency of bony outgrowth further complicates removal. Median or paramedian locations of a ventral bony compression (such as ossification of the posterior longitudinal ligament, calcified disc herniation, or circumscribed spondylosis) are not suitable for a posterior approach if the goal is to remove these pathologies. More lateral locations of the site of compression make a posterior approach more feasible.

Ventral and posterior approaches to a mediolateral or intraforaminal ventral compression have key advantages and disadvantages. While the ventral approach involves less manipulation of the exiting root, it carries the risk of injuring the vertebral artery, especially in intraforaminal locations. Excessive caution due to this risk may instead result in an insufficient extent of decompression. On the other hand, the trajectory of a posterior approach is superior, since the vertebral artery can be visualized and thereby protected from intraoperative injury. A major drawback of a posterior approach is the risk of extensive retraction on the exiting nerve root, potentially causing neurologic deficits.

Therefore, surgical discretion is often required to determine the superior approach for a given patient’s anatomy.