Fluroscopic view of docking the tubular retractor from a posterior insertion (via a 14 mm, 16 mm or 18 mm aperture). This tubular retractor allows the insertion of the camera and operating instruments necessary for visualization of the spine.

The microendoscopic view of the cervical nerve root with decompression of the foramen accomplished.

Camera is rotated to look out the nerve foramen which provides visual confirmation that the nerve is decompressed. Note the access area to the disc in this position.

Microendoscopic view of foraminal decompression of the cervical nerve root.

Keywords
Cervical Herniated Disc
Cervical Foraminal Stenosis
Cervical Foraminotomy
Posterior Cervical Discectomy
Microendosocpic Cervical Foraminotomy
Microendoscopic Cervical Discectomy
Minimally Invasive Cervical Spine Surgery

Definition
MicroEndoscopic Surgery in the cervical spine (neck) provides an enhancement to the established procedures microcervical foraminotomy (use of operating microscope) and posterolateral foraminotomy (incision and use of loupe magnification). The surgical revolution of Minimally Invasive Spinal Surgery is now applied to the cervical spine as it has been for the lumbar (low back) and thoracic (mid-back) areas.

MicroEndoscopic Surgery utilizes the advantages of traditional microsurgery. The technical enhancements of MicroEndoscopic Surgery are less tissue disruption to accomplish the surgical goal, and the superior visualization derived from different camera positions.

Why consider a MicroEndoscopic Cervical operation? The potential advantages are numerous:
1. Outpatient Neck Surgery.
2. Less incision pain.
3. 14 mm or 16 mm or 18 mm entry via "band aid style" incision with minimal alteration of normal tissue.
4. Percutaneous surgery importing the experience derived from traditional microsurgery (the surgeon sees what he/she is doing)
5. Faster potential return to work and routine life activities due to minimal alteration in the normal anatomy. (no fusion)

Indications
Indications for MicroEndosocpic Cerivcal Spine Surgery include arm pain, arm numbness, arm weakness and an imaging study (M.R.I., Myelogram and C.A.T. scan, C.T. discogram) revealing mechanical pressure on the spinal nerve from disc herniation (herniated disc) or bone spur. The "pinched nerve" is the ideal problem for MicroEndoscopic Cervical Spine Surgery.

Technical Considerations
Through a MicroEndoscopic portal different anatomic regions can be accessed: lamina, medical facet, lateral facet, formaminal entrance, the spinal nerve, the disc, and potential bone spurs.

Literature Review
Featured Review:
The feasability of microendosocpic surgery decompressing the cervical spinal nerve root has been studied.(ref #1, ref #2) In fact, the ease of access to the posteior structures is well defined.(ref #2) The clinical results of performing the minimally invasive procedures on the neck are excellent.(ref #3)

Complications
The complications of Microendoscopic Cervical Decompression or Foraminotomy are the same risks as any posterior cervical foraminotomy. The listed complications include death, paralysis, failure to improve, spinal fluid leak, instability, nerve root injury, infection, wound problems.

Author’s Comment
The advantage of Cervical Microendoscopic Disectomy (MED) or Foraminotomy (MEF) are the minially invasive nature of the procedures. Outpatient neck surgery for pinched nerves with no spinal fusion is the hall mark advantage of this operation.

References
1. Burke, T.G. and A. Caputy, Microendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy. J Neurosurg, 2000. 93(1 Suppl): p. 126-9.
2. Roh, S.W., et al., Endoscopic foraminotomy using MED system in cadaveric specimens. Spine, 2000. 25(2): p. 260-4.
3. Fontanella, A., Endoscopic microsurgery in herniated cervical discs. Neurol Res, 1999. 21(1): p. 31-8.