Last week, I performed the first endoscopic posterior cervical foraminotomy in the state of Alabama. This was a cumulation of endoscopic training and learned expertise, which I credit to numerous mentors and patients along the way! After my learning curve in lumbar and thoracic endoscopy, cervical decompression was a natural progression of growth in this exciting field.
79 year old male with severe left hand intrinsic wasting due to C8 radiculopathy, with severe cervical spondylosis. With his cervicothoracic kyphosis and neck anatomy, would have been a very challenging ACDF.
Previously, I had been performing this surgery with a tube. I can say that visualization and anatomic definition was just as good through the scope, with significantly less bleeding. In my experience, there are many cases I still prefer to do through a tube rather than the scope due to various factors but I believe PCF may be one of those game changing areas where I won’t go back.
We were able to fully decompress the nerve, skeletonizing the pedicle and following it out of the foramen. Amazingly and gratifying, SSEP signals increased significantly immediately following the decompression.
The patient was able to make a fist for the first time in a year and a half in the PACU. He was crying with joy from this simple act we take for granted daily. All this through an incision that was hard to find outside of the steri strip at a week.
I’m thankful to my local Arthrex Alabama team for the multiple after hours cadaver labs to ensure patient safety, and to St. Vincent’s Health System for investing in the utmost advances in quality spine care for our patients.
As always, grateful to be practicing spine surgery in this exciting time of innovation and can’t wait for further advances ahead!
*images posted with patient permission*
