Endoscopic Posterior Approach for Cervical Myelopathy and Radiculopathy Using Tubular Retractor: Our Experience, Surgical Technique, and Literature Review

Abstract

BackgroundEndoscopic posterior approach can effectively decompress cervical root and cord secondary to posterior compression. This publications is aimed to present our experience in 229 patients using tubular retractor and the relevant literature is reviewed. MethodsRetrospective analysis of multilevel myelopathy and or radiculopathy was performed. Indications for posterior approach was primary posterior compressions at cord and or root. Combined compression from posterior side and mild to moderate anterior pressure with acceptable lordosis were also decompressed. Bilateral cord decompression and foraminotomy for radiculopathy was performed using tubular retractor. ResultThere were myelopathy and radiculopathy in 220 and 9 patients respectively. A total of 53 foraminotomy procedures were performed in 36 patients. All patients showed improvement, with the mean preoperative Nurick grade decreasing from 2.72 ± 0.799 to 0.78 ± 0.911 after surgery. There was significant improvement in postoperative Nurick grades compared to preoperative grades (Z-value =13.306, P less than 0.0001). Operative results were better in patients with good preoperative Nurick grades (grades 1 and 2) compared to those with poorer grades (grades 3 and 4). Minor bleeding, small dural tear, and root injury was observed in 42, 4 and 8 patients respectively. ConclusionEndoscopic approach was effective and safe for root and cord decompression. This study was limited by its single-center, retrospective design, exclusion of some eligible patients, a short postoperative Nurick grade assessment period of six months, and absence of a comprehensive long-term postoperative biomechanical assessment. To validate these results, a prospective multicenter study addressing these limitations is needed.