| Full-endoscopic cervical posterior foraminotomy (FCPF) using5.9-mm endoscopes is a new technique in cervical posterior microsurgery field introduced by Ruetten in2008, during which, with the aid of an image system, the cervical prolapsed vertebral discs are taken out directly with a full-endoscopic spinal surgical instrument in posterior access to the cervical spine to remove the compression on the nerve roots. The operation has been clinically used for only a short time, and the studies on the applied anatomy related with the operative approach are only a few, especially the relationship between cervical nerve root, cervical cord, lateral mass and vertebral artery; there is no defined report about the intraoperative access point range of the full endoscope; resulted from limited clinical application, the basic number of clinical case is small, the safety and effectivity of the operation requires further confirmation, and the complications, indications and long-term therapeutic effects require the support of large sample study results.Objective1. To get known to the structural relationship between cervical nerve root, cervical cord, lateral mass and vertebral artery, and to decide the access point of FCPF operation.2. To discuss how to keep nerve root, cervical cord and vertebral artery away from damage.3. Based on available clinical cases, to preliminarily investigate the safety and effectivity of the operation.Methods1. The heights and widths of the lateral masses, the widths of the cervical cords, the lengths of the nerve roots between the cervical cords and the lateral masses, the lengths of nerve roots and the distances between vertebral arteries and cervical cords after removal of the lateral masses of5fresh dead bodies were observed. And the obtained data was statistically analyzed.2.7cervical disc herniation patients who underwent PCPF between2011and2013were retrospectively studied. The operating times and blood losses were observed. In1day,3days,1week and1month after the operation, the patients were followed up. In1month after the operation, plain cervical vertebrae films were made. The clinical therapeutic effects and potential complications were observed and recorded. The pains the patients suffered were evaluated by visual analogue scale (VAS). Results1. Observation results of the heights and widths of the lateral masses:the heights of C3-C7lateral masses were from11.31±1.12mm to11.63±1.72mm, and the widths were from10.11±1.62mm to10.11±1.62mm. The difference in C3-C7lateral mass height was insignificant. The width of C3lateral mass was the smallest,10.11±1.62mm, and that of C7was the largest,12.88±1.33mm, and the widths were in ascending order from C3to C7. And the difference in the width between C4lateral mass and C5lateral mass was insignificant.2. Nerve root lengths and horizontal ranges between the cervical cords and lateral masses, and the included angles between the nerve roots and cervical cords:after removal of the laminas of vertebra, the nerve root lengths between cervical cords and the medial margins of the lateral masses were in ascending order from C3to C7, among which, the average of C3was smallest,6.52±0.52mm, and that of C7was the largest,7.33±0.52mm. The included angle between the nerve root and cervical cord was the largest on C6plane. Those of C3-C7planes were not very variable or irregular, and all between50and60.3. The lengths and horizontal ranges between nerve roots after removal of the superior articular processes:Viewed from the determination results, after removal of the superior articular processes, the exposed nerve root lengths were gradually increased from C3to C7, among which, the average of C3was the smallest,8.44±0.87mm, and that of C7was the largest,12.34±0.88mm. The horizontal ranges were also in ascending order from C3to C7; the average of C3was the smallest,7.14±0.22mm, and that of C7was the largest,10.05±0.82mm.4. Widths of cervical cords and distances between cervical cords and vertebral arteries:The widths of cervical cords were gradually increased from C3to C7, among which, the width of C3was the smallest,14.81±0.13mm, and that of C7was the largest,21.53±0.87mm. The increasing extents in widths on cervical cord C3, C4and C5planes were significant, while those on cervical cord C5, C6and C7were slowed down. The distance between vertebral artery and cervical cord was the smallest on C3plane,7.11±1.16mm, and was the largest on C6plane,8.58±1.01mm, and each average was in ascending order from C3to C6plane. Because vertebral artery C7usually does not pass though the transverse foramen, the distance on C7plane was not measured.Conclusion 1. FCPF using a5.9-mm endoscopes, the access point of the endoscope should be the inner margin of small zygapophysial joints. On segment C3-4, the stripping range of small articular processes by an abrasive driller should be more than1.5mm away from the lateral sides of the small zygapophysial joints; while on segment C5-7, that should be about2.0mm away from the lateral sides of the small zygapophysial joints.2. FCPF using5.9-mm endoscopes can effectively relieve the symptoms of patients with cervical disc herniation, has short operating time, small postoperative blood loss, short bedrid time and a few postoperative complications, and is a safe and effective therapy for cervical disc herniation. |
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