The Jho procedure for cervical stenosis

      * Provides enlargement of the spinal cord canal that has been narrowed by bony spurs
    * Is less invasive because it is done through a small incision and does not disrupt the integrity of the spinal structures due to minimal removal of bone
    * Is innovative because it offers alternative to conventional procedure and does not require fusion of bone
    * Patients do not have to wear collars or braces following surgery
    * Patients are most often only required to stay in the hospital overnight
    * Can be done at multiple cervical levels if required

Patients who have narrowed spinal cord canals in the neck region often suffer from numbness, weakness, pain in the arms, difficulty controlling urination and possibly difficulty with walking. Compared to conventional procedures which may lack in providing access to the front portion of the canal (laminectomy technique), or may require excessive bone removal and fusion (anterior discectomy or vertebrectomy technique), this new minimally invasive technique does not significantly weaken the structures of the cervical spine but still accomplishes enlargement of the canal. In simple terms, it cleans out a spinal cord canal that has bone build-up putting pressure on the spinal cord, so that the canal may then be likened to a water pipe without accumulated inner debris. It does so by the use of small holes, made with the use of the operating microscope or an endoscope, and are called foraminotomy holes. Another useful analogy that helps explain this procedure would be to picture removing the contents of a watermelon through a hole without cutting the watermelon apart. Once the surgery is done, patients can usually go home the following day without collars or braces. Recovery usually covers the time span of 4 to 6 weeks.

Definitions

foraminotomy - enlargement of an opening or passageway for a nerve

stenosis - a narrowing of a canal

spondylotic - refers to spondylosis which is a non-inflammatory disease of the spine that can include excess bone growth

 About Dr. Hae-Dong Jho

Dr. Hae-Dong Jho is professor of Neurosurgery and director of the Jho Institute for Minimally Invasive Neurosurgery in the Department of Neurological Surgery. He had been assistant professor, associate professor and professor of Neurosurgery at the University of Pittsburgh from July 1989 till 2001. He moved his practice to Allegheny General Hospital in Pittsburgh, Pennsylvania and has been appointed as professor of Neurosurgery at the Drexel University School of Medicine Allegheny General Hospital since 2002.

Despite advances in the art of neurosurgery, the risk of surgery for brain and spinal diseases is still significant. It is even greater for surgery involving skull base tumors, cerebral aneurysms and complex spinal diseases. Escalating health care costs are another important concern. Ideal neurosurgical treatment should provide patients with cure of the disease along with minimal risk and rapid recovery. Dr. Jho has developed numerous innovative neurosurgical techniques that have been applied to patient care for many years. Among these techniques are endoscopic transsphenoidal pituitary surgery through a nostril without skin incision or nasal packing, endoscopic skull base surgery through a nostril for various skull base tumors, a "Band-Aid" craniotomy via a small nose bridge skin incision for midline anterior skull base tumors, a "Band-Aid" craniotomy via a small lateral eyebrow incision (so called orbital roof craniotomy) for meningiomas, craniopharyngiomas and other skull base tumors, a "Band-Aid" craniotomy via a small eyebrow incision (so called superolateral orbital craniotomy) for parasellar tumors and cerebral aneurysms, a subtemporal approach through a small temple incision for skull base tumors and aneurysms, and a retromastoid approach for tumors, cranial nerve diseases, and aneurysms. Postoperatively, patients wear a small "Band-Aid". Most operations are performed with an endoscope through a small and precise exposure. Brain retractors are never used in order to avoid unwanted brain retraction injury. Patients undergoing these cranial operations often stay in the hospital for a day or two.

New endoscopic surgical techniques for spinal diseases have also been developed by Dr. Jho. These innovative procedures include a minimally invasive disc-preserving anterior cervical foraminotomy for cervical disk herniation, minimally invasive spinal cord decompression via anterior foraminotomy for cervical stenosis, an anterolateral or posterolateral approach for cervical spinal cord tumors, minimally invasive endoscopic thoracic discectomy, minimally invasive endoscopic lumbar discectomy, minimally invasive endoscopic decompression for lumbar stenosis, etc. Anterior foraminotomy for cervical disc herniation is a new surgical technique which removes only the herniated portion of the disc and preserves the remaining disc intact. Spinal bone fusion or metal implant is not necessary. Normal neck motion is well preserved with this new surgical technique. Spinal cord decompression for cervical stenosis is also performed via anterior foraminotomy. This operation for cervical stenosis does not require bone fusion or metal implant, and does not require the use of a postoperative brace. When the spinal cord tumor is located anteriorly to the cervical spinal cord, the tumor is removed via an anterior foraminotomy or a posterolateral approach. With these techniques, bone fusion is not necessary after tumor removal. Endoscopic transpedicular thoracic discectomy is performed via a 2-cm incision. With these minimally invasive operations, patients usually recover quickly with minimal discomfort and short hospital stay. Thus, Dr. Jho's minimally invasive spinal surgery can be called functional spinal surgery in that the normal anatomy and function is preserved as much as possible. However, If required with spinal instability caused by tumor invasion or trauma, spinal instrumentation and bone fusion can also performed by minimally invasive techniques.