# Minimally Invasive Tubular Posterior Cervical Laminectomy in Medically Complex Patients: A Case Series With Clinical and Radiographic Outcomes

## TL;DR

This study shows that a minimally invasive cervical surgery is safe and effective for patients with complex medical conditions.

## Contribution

The study provides clinical and radiographic outcomes of tubular posterior cervical laminectomy in medically complex patients.

## Key findings

- Mean improvement in radiographic canal distance was 4.9 mm (p<0.05).
- Modified Japanese Orthopaedic Association scores improved from 10.8 preoperatively to 12.3 postoperatively (p<0.05).
- No perioperative complications or reoperations occurred in the follow-up period.

## Abstract

Objectives

Minimally invasive (MIS) techniques have become increasingly favored for cervical decompression. Among them, tubular posterior cervical laminectomy represents a promising option for patients with significant medical comorbidities. However, radiographic outcomes associated with this technique have not been fully described. The objective of this study is to evaluate clinical and radiographic outcomes of this approach in medically complex patients.

Materials and methods

This retrospective case series examined all patients who underwent an MIS tubular cervical laminectomy for bilateral decompression by a single surgeon. Demographic, clinical, and radiographic outcomes were collected.

Results

Eighteen patients (12 (67%) male) were identified with a mean age of 76 years, a mean body mass index of 28 kg/m2, and mean follow-up of 23 months (range 3-40). All patients had cervical stenosis with additional diagnoses of cervical myelopathy (n=15 (83%)), adjacent segment disease (n=3 (17%)), syringomyelia (n=1 (6%)), and dorsal epidural abscess (n=1 (6%)). Mean American Society of Anesthesiologists class was 3.2 (range 2-4) with comorbidities including coronary artery disease (n=5 (28%)), congestive heart failure (n=2 (11%)), and aortic stenosis (n=2 (11%)). Median operative levels were 2 (range 1-3). Mean operating skin-to-skin time was 79 minutes (one level), 112 minutes (two levels), and 146 minutes (three levels) with estimated blood loss <50 cc in all cases. Eleven (79%) of 14 elective patients were discharged the same day, with three patients (21%) admitted for rehabilitation disposition planning. Mean improvement in the radiographic anterior-posterior central canal distance was 4.9 mm (p<0.05) and axial cross-sectional area was 71.9 mm2 (p<0.05). Modified Japanese Orthopaedic Association scores showed improvements of a mean preoperative 10.8 to mean postoperative 12.3 (p<0.05). There were no perioperative complications or reoperations during the follow-up period.

Conclusions

MIS tubular cervical laminectomy demonstrated successful clinical and radiographic outcomes in this case series. This approach should be considered as a safer alternative to open surgeries, especially in medically complex patients.