1. David W. Lowry MD1, Scott M. Tuinstra PA-C1, Joseph A. Sclafani MD2
Initial Clinical Outcomes After Cervical Transcorporeal Discectomy or Foramenotomy with Vertebral Body Access Channel Repair
David W. Lowry MD1, Scott M. Tuinstra PA-C1, Joseph A. Sclafani MD2
1. The Brain and Spine Center, Holland, MI
2. Milestone Research Organization, San Diego, CA
Channel Guide
Background Information
Transcorporeal microdecompression (TCMD) is a motion sparing, minimally invasive cervical spine procedure.
TCMD utilizes a small channel through the cervical vertebrae to decompress areas of central or foraminal stenosis while preserving the native disc.
TCMD can be performed as a stand-alone or hybrid procedure with ACDF at the adjacent levels.
Guide is oriented with respect to midline and midpoint
Anchoring pin secures guide during drilling
Entry point centered 4mm lateral to body midpoint, ipsilateral to target pathology
Channel 6mm wide; drilled to depth of AP diameter less 3mm (“AP minus 3”)
Guide directs trajectory toward pathology located posterior to uncovertebral joint
10 degrees caudal (alternative option for some situations: 5 degrees caudal)
5 degrees lateral
Methods
Single site, retrospective review of patient based outcome measures (VAS, NDI, return to work) in patients treated with isolated TCMD using a trajectory control guide and with channel repair (Beta-tricalcium phosphate + local autograft; TransCorp Spine, Byron Center, Michigan, USA) or TCMD + ACDF at the adjacent level.
Statistical analysis using paired t-tests (p<0.05)
Outcome measures were:
Neck Disability Index (NDI)
Axial pain Visual Analog Scale (VAS)
Radiating pain Visual Analog Scale (VAS)
Return to work (RTW) or usual activity in days.
Conclusions
Within the limits of a retrospective, single-surgeon study, patients did experience both functional improvement and pain relief from standalone TCMD or combined ACDF / TCMD procedures.
Definitive statements on long-term efficacy, disc space preservation, and motion preservation await further study.
Channel Repair 1. 2. 3.
Acknowledgement
The authors wish to thank both Desmond O’Farrell of TransCorp Spine and Roger Veldman of Hope College, Holland, Michigan, USA for engineering expertise; and the staff of The Brain + Spine Center for clinical support.
Findings
Among 62 patients, there were no cases of neurovascular injury, CSF leak, transfusion, or migration of repair implement
Revision surgery was required in 6.4% (n=4) patients
Analysis of outcome metrics was performed for patients that underwent standalone TCMD (TCMD group, n=42) and TCMD with concurrent ACDF at one or more levels (TCMD+ACDF group, n=20)
TCMD group NDI improved from 20.0 to 2.7 at 1 year (p = ); Axial VAS improved from 5.5 to 0.6 (p = ); and Radiating VAS improved from 7.1 to 0.6 (p = ).
TCMD+ACDF group NDI improved from 22.0 to 4.0 at 1 year (p = 0.004); Axial VAS improved from 7.1 to 1.2 (p = 0.01); and Radiating VAS trended towards significant improvement from 6.4 to 2.3 (p = 0.09)
Mean return to work was 10 days in the TCMD group and 57 days in the TCMD+ACDF group
Postop 4 weeks
Postop 12 weeks
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