Posterior Central Laminectomy for Bilateral Decompression under a Unilateral Biportal Endoscopic approach for Multi-segmental Cervical Stenosis: Anatomic and Technical note

Abstract

Abstract Background Cervical spondylotic myelopathy (CSM) caused by multi-segment cervical stenosis is a common spinal surgery disease with severe neurological dysfunction. The surgical goal was to achieve full canal decompression while minimizing damage to the normal structures. Unilateral biportal endoscopy (UBE), due to its good visualization, independent view-working portals, and wider instrument availability, can be utilized to efficiently and safely complete a laminectomy under endoscopy. Objective This study was to determine the efficiency and safety of a novel cervical laminectomy technique and introduce some new endoscopic anatomic concepts. Methods We report on 3 cases of multi-segment of cervical stenosis. The author attempted combinations of "laminectomy", "hemilaminectomy", and "ligamentum flavum resection" under UBE for different cervical cases. The postoperative neurological improvement and perioperative complications were used to determine the efficiency and safety. Results All 3 patients got significant improvement after surgery. And no complication was observed. This study described in detail the surgical steps and introduced new anatomic concepts that "infraspinous absence range (IS-AR)" and "ligamentum flavum-interspinous space (LF-IS space)". Conclusion Central laminectomy for bilateral decompression (CLBD) under UBE is an effective surgical method for the treatment of CSM caused by multi-segment cervical spinal stenosis. It can achieve the same decompression effect as traditional open cervical laminectomy while protecting the paraspinal muscles and posterior ligament complex which can avoid postoperative axial symptoms and cervical stiffness. However, due to the small size of the spinal canal and the small perturbation tolerance of the cervical spinal cord, the learning curve will be slightly high. China Clinical Trial registration number：ChiCTR2200065144.