Minimalinvasive Chirurgie an der Halswirbelsäule: Evidenz, Tipps und Tricks

Zusammenfassung

Analog zur Chirurgie an der Brust- und Lendenwirbelsäule, ist es auch an der Halswirbelsäule das Bestreben der minimalinvasiven-Techniken (MIS), hinsichtlich der „target surgery“ vergleichbare Ergebnisse zu den konventionellen Verfahren zu erzielen. Gleichzeitig aber die Vorteile einer weniger traumatisierenden „access surgery“ zu bieten. Im Unterschied zur BWS und LWS, kommen MIS-Techniken an der HWS überwiegend dorsal zum Einsatz. Dies reduziert nicht ihre Bedeutung, da die zervikale Muskulatur sowohl biomechanisch – Halten des Kopfgewichtes – als auch neurophysiologisch – Halten des Sehhorizonts – sehr anspruchsvolle Funktionen erfüllt. Die Notwendigkeit die zugangsbedingte Muskeltraumatisierung operativ zu minimieren ist selbsterklärend.

Im Folgenden werden bekannte operative Verfahren in einer „aktualisierten“ Version vorgestellt: Bei der posterioren Foraminotomie führt der transmuskuläre Zugang zu einer Reduktion der Zugangsmorbidität. Die Laminoplastie ist im asiatischen Raum ein etabliertes Verfahren zur Dekompression der multisegmentalen zervikalen Stenose. Die hier vorgestellte unilaterale Variante ist weniger verbreitet, entbehrt aber nicht einer klinischen Begründung. Die Ergänzung mit einer unilateralen Instrumentation erweitert das Indikationsspektrum und wird auch von Kollegen in Fernost beginnend angewendet. Die C1/C2 Instrumentation gewinnt durch die Navigation an „Standardisierung“ und somit an Sicherheit. Die subaxiale Navigation begleitet den Wandel von dem offenen zum perkutanen Einbringen von Pedikelschrauben.

Die erwähnten operativen Verfahren unterscheiden sich hinsichtlich Indikation, technischer Durchführung und Akzeptanz. Eines ist ihnen gemeinsam: Die größtmögliche operative Sicherheit mit dem Erhalt die Physiologie der Nackenmuskulatur zu vereinbaren.

Abstract

As in the thoracic and lumbar spine, MIS techniques of the cervical spine strive to achieve results comparable to those of conventional procedures in terms of “target surgery”, while at the same time offering the advantages of less traumatizing “access surgery”. However, unlike in the thoracic and lumbar spine, MIS techniques on the cervical spine are predominantly used dorsally. This does not reduce their importance, as the cervical muscles perform very demanding functions both biomechanically – holding the weight of the head – and neurophysiologically – holding the visual horizon. Thus, the need to surgically minimize access-related muscle trauma is self-explanatory.

In the following, well-known procedures such as posterior foraminotomy are presented, but in an "updated" version (transmuscular approach). Laminoplasty is in the Asian region an established procedure for decompression of multilevel cervical stenosis. The unilateral variant presented here is still not very common but does not lack clinical justification. The addition of unilateral instrumentation expands its range of indications and is also beginning to be used by colleagues in the Far East. C1/C2 instrumentation gains "standardization" and thus safety through navigation. While subaxial navigation accompanies the change from open to percutaneous insertion of pedicle screws.

The surgical procedures mentioned above differ in terms of indication, technical implementation, and acceptance. They all have one thing in common: to combine the highest possible surgical safety with the preservation of the physiology of the neck muscles.

Schlüsselwörter

Halswirbelsäule - dorsale Techniken - minimalinvasive Chirurgie - Foraminotomie - Laminoplastie

Keywords

Cervical spine - posterior techniques - minimal-invasive surgery - laminoplasty - foraminotomy

Publication History

Article published online:
24 August 2023

• Literatur

• 1 Broekema AEH, de Souza NFS, Soer R. et al. Noninferiority of posterior cervical foraminotomy vs anterior cervical discectomy with fusion for procedural success and reduction in arm pain among patients with cervical radiculopathy at 1 year. The FACET Randomized Clinical Trial. JAMA Neurology 2022; E1-E9
• 2 Henderson CM, Hennessy RG, Shuey HM. et al. Posterior-lateral foraminotomy as an exclusive technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery 1983; 13: 504-512
• 3 Winder MJ, Thomas KC. Minimally invasive versus open approach for cervical laminoforaminotomy. Can J Neurol Sci 2011; 38: 262-267
• 4 Tumialan LM, Ponton RP, Gluf WM. Management of unilateral cervical radiculopathy in the military: the cost effectiveness of posterior cervical foraminotomy compared with anterior cervical discectomy and fusion. Neurosurg Focus 2010; 28: E17
• 5 Papavero L. Essential step-by-step techniques for minimally invasive spinal surgery. Chap. 20. 1. Aufl. Thieme Verlag; 2022
• 6 Eicker SO, Steiger HJ, El-Kathib M. A transtubular microsurgical approach to treat lateral cervical disc herniation. World Neurosurgery 2016; 88: 503-509
• 7 Barakat M, Youssef H. Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study. " European Spine Journal 2012; 21: 1383-1388
• 8 Lee DG, Park CK, Lee DC. Clinical and radiological results of posterior cervical foraminotomy at two or three levels: a 3-year follow-up. Acta Neurochir 2017; 159: 2369-2377
• 9 Jagannathan J, Sherman JH, Shaffrey T. et al. The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 yearsʼ clinical and radiographic follow-up. J Neurosurg Spine 2009; 10: 347-356
• 10 Lee YS, Kim YB, Park SW. et al. Preservation of motion at the surgical level after minimally invasive posterior cervical foraminotomy. J Korean Neurosurg Soc 2017; 60: 433-440
• 11 Cho TG, Kim YB, Park SW. Long Term Effect on Adjacent Segment Motion after Posterior Cervical Foraminotomy. Korean J Spine 2014; 11: 1-6
• 12 Skovrlj B, Gologorsky Y, Haque R. et al. Complications, outcomes, and need for fusion after minimally invasive foraminotomy and microdiscectomy. Spine J 2014; 14: 2405-2411
• 13 Komp M, Oezdemir S, Hahn P. et al. Full-endoscopic posterior foraminotomy surgery for cervical disc herniations. Oper Orthop Traumatol 2018; 30: 13-24
• 14 Liu Wj, MDHu L, MDChou PH. et al. Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review. Orthop Surg 2016; 8: 425-431
• 15 Mielke D, Rohde V. Bilateral spinal canal decompression via hemilaminectomy in cervical spondylotic myelopathy. Acta Neurochir (Wien) 2015; 157: 1813-1837
• 16 Hernandez RN, Soriano-Solis S, Soriano-Sanchez JA. Essential step-by-step techniques for minimally invasive spinal surgery Chap. 21. 1. Aufl. Thieme Verlag; 2022
• 17 Carr DA, Abecassis IJ, Hofstetter CP. Full endoscopic unilateral laminotomy for bilateral decompression of the cervical spine : surgical technique and early experience. J Spine Surg 2020; 6: 447-456
• 18 Papavero L, Pietrek M, Marques CJ. et al. Cervical single-level pincer stenosis causing myelopathy: A technical note and medium-term results of a one-session microsurgical 360-degree treatment. J Neurol Surg A Cent Eur Neurosurg 2022; 83: 187-193
• 19 Kaptain GJ, Simmons NE, Replogle RE. et al. Incidence and outcome of kyphotic deformity following laminectomy for cervical spondylotic myelopathy: a systematic review. J Neurosurg 2000; 93: 199-204
• 20 Yoon ST, Hashimoto RE, Raich A. et al. Outcomes after laminoplasty compared with laminectomy and fusion in patients with cervical myelopathy: a systematic review. Spine 2013; 38 (Suppl. 22) S183-194
• 21 Kim P, Murata H, Kurokawa R. Myoarchitectonic spinolaminoplasty: efficay in reconstituting the cervical musculature and preserving biomechanical function. J Neurosurg Spine 2007; 7: 293-304
• 22 Shiraishi T. Skip-laminectomy-a new treatment for cervical spondylotic myelopathy preserving bilateral muscular attachements to the spinous processes: a preliminary report. Spine J Off J North Am Spine Soc 2002; 2: 108-115
• 23 Kulkarni V, Chandy MJ, Babu KS. Quantitative study of muscle spindles in suboccipital muscles of human foetuses. Neurol India 2001; 49: 335-339
• 24 Roselli R, Pompucci A, Formica F. et al. Open-door laminoplasty for cervical stenotic myelopathy: surgical technique and neurophysiological monitoring. J Neurosurg 2000; 92 (Suppl. 01) 38-43
• 25 Schmeiser G, Kothe R. Posteriore Dekompressionstechniken an der Halswirbelsäule bei spondylogener zervikaler Myelopathie. Die Wirbelsäule 2020; 04: 275-281
• 26 Schmeiser G, Bergmann JI, Papavero L. et al. A feasibility study. J Neurol Surg A Cent Eur Neurosurg 2022; 83: 494-501
• 27 Richter M, Cakir B, Schmidt R. Cervical Pedicle Screws: Conventional Versus Computer-Assisted Placement of Cannulated Screws. Spine 2005; 30: 2280-2287
• 28 Coric D, Rossi V, Peloza J. et al. Percutaneos, navigated minimally invasive posterior cervical pedicle screw fixation. Int J Spine Surg 2020; 14: S14-S21 doi
• 29 Kothe R. Rheumatische Fehlstellungen an der HWS unter besonderer Berücksichtigung der C1/C2-Stabilität – Aktuelle Diagnostik und Therapiestrategien. Die Wirbelsäule 2018; 2: 272-278 doi
• 30 Weidner A, Wähler M, Chiu ST. et al. Modification of C1-C2 transarticular screw fixation by image guided surgery. Spine 2000; 25: 2668-2674
• 31 Srikantha U, Khanapure KS, Jagannatha AT. et al. Minimally invasive atlantoaxial fusion: cadaveric study and report of 5 clinical cases. J Neurosurg Spine 2016; 25: 675-680doi/abs/