Decompressive Footplate Cervical : Technique and Outcomes Byron Branch MD; David F. Jimenez MD, FACS Department of , University of Texas Health Science Center at San Antonio

Introduction Results References Figure 1 Figure 2 Removal of the spinous process and 1. Demographic data on 43 2.Epstein JA. The surgical bilateral laminar arches consecutive adult patients undergoing management of cervical spinal (laminectomy) has been used as a this technique as performed by a stenosis, spondylosis, and standard surgical technique to access single surgeon from 1998-2013 is myeloradiculopathy by means of the the spinal canal and its contents. The presented in Table 1. posterior approach. Spine 13:864- , dura, intervertebral discs 2. All patients received a 869, 1988 and any associated pathology of decompressive laminectomy only. 3.Graham JJ. Complications of cervical these structures can be approached The average length of surgery was spine surgery: A five-year report on a using this technique. Traditionally, 106 minutes and mean estimated survey of the membership of the two common techniques for cervical blood loss was 50 mL. The number of cervical spine research society by the laminectomy include careful thinning levels decompressed ranged from 1 morbidity and mortality committee. of the laminae with a round or olive to 4 with an average of 2.6 levels Spine 14:1046-1050, 1989 burr or the use of a match stick bit to undergoing decompressive 4.Kaptain GJ, Simmons NE, Replogle create bilateral troughs for removal of laminectomy. Distributions of RE, Pobereskin L. Incidence and Table 1 the arches [7,10,11]. In 1992, presenting diagnosis and cervical outcome of kyphotic deformity Cochrane and Steinbok published a levels of involvement are presented in Figure 3 following laminectomy for cervical small case series depicting the use of Table 2. spondylotic myelopathy. J Neurosurg the footplate attachment (Midas Rex 3. One patient developed a superficial (Spine 2) 93:199-204, 2000 B5 foot attachment) to perform wound infection treated with bedside 5.Keller T. Historical Perspective: laminoplasties in children [1]. We debridement and oral antibiotics and Victor Horsley’s surgery for cervical adapted this technique to perform two patients developed surgical site caries and fracture. Spine 21:398-401, in adults requiring seroma/hematoma requiring 1996 laminectomies of the cervical, drainage. All three of these patients Table 2 6.Komotar RJ, Mocco J, Kaiser MG. thoracic, and lumbar spine. A ultimately had a satisfactory Surgical management of cervical detailed description of the procedure outcome. One of the patients who myelopathy: indications and and the results of our consecutive developed a postoperative seroma techniques for laminectomy and series is presented. had a preoperative diagnosis of fusion. Spine J 6:S252-S267, 2006 epidural abscess. 7.Lu JJ. Cervical Laminectomy: 4. Length of stay and follow up data Technique. Neurosurgery 60(Suppl Methods was available for all 43 patients. The 1)S149-S153, 2007 A retrospective hospital chart analysis hospital length of stay ranged from 2 8.Mummaneni PV, Kaiser MG, Matz PG, of 43 consecutive adult patients to 49 days with an average length of et al. Cervical surgical techniques for undergoing this technique for stay of 7.2 days. The patient with Conclusions the treatment of cervical spondylotic treatment of cervical epidural abscess was an outlier The technique presented herein for References myelopathy. J Neurosurg Spine as performed by a single surgeon having a hospital stay of 49 days decompression of a stenotic cervical 1.Cochrane DD, Steinbok P. 11:130-141, 2009 between the years 1998-2013 was while receiving IV antibiotics, spine, using the high speed drill Laminotomy: a technical note. 9.Ryken TC, Heary RF, Matz PG, et al. undertaken with Institutional Board however this was still included in the footplate bilateral osteotomies, may Child’s Nerv Syst 8:226-228, 1992 Cervical laminectomy for the Review approval. average length of stay. Patients were be a safe and effective alternative. It treatment of cervical degenerative The patient is positioned prone with followed for an average of 9.75 has not been associated with new myelopathy. J Neurosurg Spine Learning Objectives the head slightly flexed in a Mayfield months. Five patients developed neurological deficits nor the need for 11:142-149, 2009 1) Consider this technique as another 3-point fixation. The levels to be transient focal dysethetic pain reoperation. Follow up did not reveal 10.Scoville WB. Cervical spondylosis alternative by which one can access removed are exposed as well as the postoperatively which resolved during cervical spinal instability and no treated by bilateral facetectomy and and decompress the cervical spine. junctional ligamentum flavum of the the follow up period. These patients patient required cervical fusion. laminectomy. J Neurosurg 18:423- 2)Describe the technical nuances level above and below. A curet is were treated with gabapentin until 428, 1961 involved in the performance of this used to free the ligamentum flavum their symptoms resolved. No 11.Taylor AR, Aberd MB. Mechanism technique. from the lower most level. A patients required additional surgery and treatment of spinal-cord disorders footplate attachment drill is used to for recurrent stenosis. No patients associated with cervical spondylosis. create a continuous osteotomy at the went on to develop instability Lancet 261:717-720, 1953 junction of the lamina and facet joint requiring cervical fusion. All patients at all levels of interest Figures 1&2. had improvement or stabilization of Once done bilaterally, the entire symptoms at their final follow up osseo-ligamentous complex is visit, none had a worse outcome elevated as a single unit. postoperatively.