McAnany Steven J, Qureshi Sheeraz A
Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia.
Department of Orthopedics, Mount Sinai Medical Center, New York, NY.
JBJS Essent Surg Tech. 2016 Jun 8;6(2):e23. doi: 10.2106/JBJS.ST.16.00012. eCollection 2016 Jun 22.
The minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis.
STEP 1 POSITION THE PATIENT VIDEO 1: Place the patient in a prone position on a Jackson table with 6 posts and with the head resting comfortably on a soft facial pillow, and tape the shoulders down to provide traction to the skin and help with fluoroscopic visualization of the lower cervical levels.
STEP 2 PERFORM THE SKIN INCISION: Make the skin incision adjacent to the spinous process on the side of the abnormality over the operative level.
STEP 3 USE TUBULAR DILATORS TO MAKE A WORKING PORTAL: Use sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level.
STEP 4 PERFORM THE LAMINOFORAMINOTOMY VIDEO 2: Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen.
STEP 5 PERFORM THE FORAMINAL DECOMPRESSION VIDEO 3: Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression.
STEP 6 WOUND CLOSURE AND POSTOPERATIVE CARE: Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure.
A systematic review and meta-analysis of studies on open or minimally invasive surgical (MIS) techniques for posterior cervical foraminotomy showed a pooled clinical success rate of 92.7% for the 509 patients managed with the open technique and 94.9% for the 208 patients who had the MIS technique; the difference was not significant (p = 0.418).
微创后路颈椎椎间孔切开术是一种保留运动功能的手术，对于因外侧椎间盘突出或椎间孔狭窄继发单侧神经根病的患者而言，是一种理想的治疗方法。
步骤1 患者体位 视频1：将患者置于配有6根立柱的杰克逊手术台上，呈俯卧位，头部舒适地靠在柔软的面部枕头上，并用胶带固定肩部，以牵拉皮肤，便于在透视下观察下颈椎节段。
步骤2 皮肤切口：在手术节段异常一侧的棘突旁做皮肤切口。
步骤3 使用管状扩张器建立工作通道：使用连续扩张器建立工作通道，并将工作套管固定在手术节段的椎板-小关节交界处上方。
步骤4 椎板椎间孔切开术 视频2：使用高速钻头和克里森咬骨钳进行椎板椎间孔切开术，以形成进入椎间孔的工作窗口。
步骤5 椎间孔减压 视频3：用神经钩向上牵拉神经根，进行椎间盘切除术和减压。
步骤6 伤口缝合与术后护理：用电灼或止血泡沫止血，并用标准分层缝合法闭合伤口。
一项关于开放性或微创外科（MIS）技术用于后路颈椎椎间孔切开术的系统评价和荟萃分析显示，采用开放技术治疗的509例患者的综合临床成功率为92.7%，采用MIS技术治疗的208例患者的综合临床成功率为94.9%；差异无统计学意义（p = 0.418）。
