Cervical Endoscopic Unilateral Laminotomy for Bilateral Decompression (CE-ULBD)

Abstract

AbstractPerforming surgeries in the cervical spine endoscopically is gaining more and more traction. Nowadays, there are four standard surgeries, which can be done endoscopically in the cervical spine; anterior endoscopic cervical discectomy (AECD), posterior endoscopic cervical discectomy (PECD), posterior endoscopic cervical foraminotomy (PECF), and cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD). Some authors consider “posterior cervical endoscopic ventral bony decompression” as a separate entity, counting it as the fifth procedure. Beyond these standard procedures, there are numerous individually adapted special approaches for not so common pathologies.Endoscopic procedures in the cervical spine are preferentially performed through a posterior approach. This chapter will focus on the standard procedure of CE-ULBD, a procedure intended for decompression of a cervical central canal stenosis. In cases of moderate and severe stenosis/myelopathy, there is a clear recommendation for surgical treatment.In microsurgery, anterior cervical discectomy and fusion (ACDF) is commonplace for the treatment of cervical spinal stenosis. However, the standard endoscopic anterior approach has limited range of motion and allows the use of only small instruments and therefore remains a procedure primarily reserved for the removal of (small) fresh disc herniations. Performing CE-ULBD through a posterior approach enables to effectively decompress a central stenosis due to sufficient mobility of the endoscope and the use of effective endoscopic decompression instruments such as power burrs.Nowadays, CE-ULBD is characterized in the literature. Beyond studies of feasibility, different authors could prove noninferiority of CE-ULBD in regard to Japanese Orthopedic Association (JOA) score and superiority in terms of duration of surgery, intraoperative blood loss, and length of hospital stay in comparison to microsurgical ACDF.KeywordsCervical spinal canal stenosisSpinal cord compressionCervical myelopathyCE-ULBDCervical laminotomyPosterior cervical endoscopic decompression