Introduction

Posterior transpedicular decompression has become a standard surgical procedure to achieve anterior spinal cord decompression; however, one of the main disadvantages of posterior transpedicular decompression is inadequate visualization of the anterior surface of the dura. Because most pathologies cause anterior spinal cord compression, surgeons frequently have to rely on palpation to assess the adequacy of spinal cord decompression. This video describe a technique that involves the use of an arthroscope to visualize the anterior surface of the dura during transpedicular decompression.

Methods

A total of 20 consecutive patients with a neurologic deficit underwent surgical treatment via an arthroscopic-assisted, unilateral transpedicular approach performed by a single surgeon. The pathologies managed included tuberculosis (12 patients), fracture (6 patients), and metastasis (2 patients). The preoperative, intraoperative, and postoperative records of the patients were retrospectively reviewed. A 70° arthroscope was used in 11 patients, and a 30° arthroscope was used in nine patients.

Results

The 30° and 70° arthroscopes afforded good visualization of the anterior surface of the dura during decompression without manipulation of the spinal cord. Adherent epidural cuff in patients with tuberculosis could be peeled off the dura under direct visualization. Complete decompression on the far lateral side could be visually assessed despite the use of a unilateral transpedicular approach alone. Visualization was poor in two patients who underwent surgical treatment for the management of metastasis because of the repeated pooling of blood in the anterior cavity. The mean surgical time was 4.5 hours, and the mean blood loss was 477 mL. Neurologic recovery occurred in all the patients with tuberculosis. No neurologic deterioration was reported. No iatrogenic dural tears were noted.

Conclusion

Arthroscopic-assisted transpedicular decompression may improve the surgical field and magnification, thereby ensuring complete decompression without injuring the dura or the spinal cord. Since most surgeons have access to an arthroscope, the use of an arthroscope during transpedicular decompression is a useful trick.