Original Article

Endoscopic Microdecompressive Cervical Discectomy and Foraminal Decompression

J Chiu

Citation

J Chiu. Endoscopic Microdecompressive Cervical Discectomy and Foraminal Decompression. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 1.

Abstract


Purpose: To demonstrate outpatient endoscopic microdecompressive cervical discectomy and foraminal decompression, with low energy non-ablative Holmium laser for disc shrinking and tightening effect (laser thermodiskoplasty), performed for treatment of symptomatic herniated cervical disc to be efficacious and safe, and preserves spinal motion.


Materials and Methods: Since 1995, 2218 patients (3691 Discs), who failed at least 12 weeks of conservative care were treated. Levels were C2 to C7, inclusive. All patients demonstrated unilateral radicular pain of a specific dermatome, single level or multiple levels, confirmed with EMG/NCV. MRI or CT scans demonstrated the herniated cervical disc. Anterior endoscopic microdecompressive cervical discectomy and foraminal decompression technique is described. Non-ablative lower Holmium laser energy was added for disc shrinkage.

Results: Average time to return to work was ten days. At an average follow-up of 4.2 years. For single level, 94% had good to excellent symptomatic relief and spinal motion preservation. There were no intraoperative complications. Postoperatively, one patient with transient Horner's syndrome and one transient hoarseness voice were noted. Seventy five patients (6%) had persistent neck and upper extremity pain associated with parasthesia, after surgery.

Conclusion: This endoscopic microdecompressive cervical discectomy and foraminal decompression with added application of non-ablative lower Holmium laser energy for disc shrinkage (laser thermodiskoplasty), has proven to be safe, less traumatic, easier, and efficacious with significant economic savings. It preserves spinal motion and provides a channel for spinal arthroplasty. It is an effective alternative or replacement for conventional open cervical spinal surgery for discectomy, and can decompress stenosis, in degenerative spine disease.

 

References

1. Choy DSJ, Ascher PW, Saddekni S, Alkaitis D, Liebler W, Hughes J, Diwan S, Altman P: Percutaneous Laser Lumbar Disc Decompression - a new therapeutic modality. Spine 17 (8): 949-956, Aug. 1992.
2. Bailey RW, Badgely CE. Stabilization of the cervical spine by anterior fusion. Bone Joint Surg 1958; 40A:607-624.
3. Cloward RB: The anterior approach for removal of ruptured cervical discs. J Neurosurg l958; 15:602-617.
4. Robinson RA, Smith GW: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 1955; 96:223-224.
5. Robertson, JT: Anterior removal of cervical disc without fusion. Clin Neurosurg 1973; 20:259.
6. McCulloch J, Young P. Complications of cervical spine microsurgery. In: Essentials of Spinal Microsurgery; Lipincott-Raven 1998; 209-215.
7. Shea M; Takeuchi TY; Wittenberg RH; White AA 3rd; Hayes WC. A comparison of the effects of automated percutaneous diskectomy and conventional diskectomy on intradiscal pressure, disc geometry, and stiffness. Journal of Spinal Disorders 1994; 7:317-25.
8. Chiu J, Clifford T, Princenthal R, Junctional Disc Herniation in Post Spinal Fusion Treated with Endoscopic Spine Surgery: In, Szabo Z, Coburg AJ, Savalgi R, Reich H, Yamamotto M, eds. Surgical Technology International XIV, UMP, San Francisco, CA 2005: p.305-315
9. Chiu J, Clifford T, Sison R. Anterior Endoscopic Cervical Microdiscectomy: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 54:p409-414
10. Lee, SH. Comparison of percutaneous endoscopic discectomy to open anterior discectomy for cervical herniations. J Minimally Invasive Spinal Technique 2001;1:17-19.
11. Hijikata S.: Percutaneous nucleotomy: A new concept of technique and 12 years experience Clin Orthop 1989;238:9-23.
12. Chiu J. Anterior Endoscopic Cervical Microdiscectomy. In: Kim D, Fessler R, Regan J, eds. Endoscopic Spine Surgery and Instrumentation. New York: Thieme Medical Publisher;2004: Chapter 5, pp 48-58.
13. Onik G, Mooney V, Maroon JC et al. Automated percutaneous discectomy: A prospective multi-institutional study. Neurosurgery 1990;26:228-233.
14. Chiu J, Digital Technology Assisted Minimally Invasive Spinal Surgery (MISS) for Spinal Motion Preservation. In: Lemke H.U, Vannier MN, Invamura RD, eds. Computer Assisted Radiology and Surgery. Amsterdam, San Diego, Oxford, London: Elsevier Medical Publisher; 2004, pp 461-466.
15. Krause, D, Drape JL, Jambon F et al. Cervical nucleolysis: indications, technique, results. 190 patients. J Neuroradiol 1993;20:42-59.
16. Kambin P: Posterolateral percutaneous lumbar discectomy and decompression: arthroscopic microdiscectomy. In: Kambin P, ed. Arthroscopic Microdiscectomy: Minimal Intervention in Spinal Surgery. Baltimore: Urban & Schwarzenberg; 1991:67-100.
17. Mayer HM, Brock M. Percutaneous endoscopic discectomy: Surgical technique and preliminary results compared to microsurgical discectomy. J Neurosurg 1993;78:21-25.
18. Schreiber A, Suezawa Y, Leu HJ. Does percutaneous nucleotomy with discoscopy replace conventional discectomy? Eight years of experience and results in treatment of herniated lumbar disc. Clin Orthop 1989;238:35-42.
19. Chiu JC, Hansraj K, et al.raspberryercutaneous (endoscopic) decompressive discectomy for non-extruded cervical herniated nucleus pulposus, In, Szabo Z,Lewis J, Savalgi R, Fantini G, eds. Surgical Technology International VI 1997 UMP, San Francisco, CA, pp. 405-411
20. Chiu J, Evolving Transforaminal Endoscopic Microdecompression for Herniated Lumbar Discs and Spinal Stenosis: In, Szabo Z, Coburg AJ, Savalgi R, Reich H, eds. Surgical Technology International XIII, UMP, San Francisco, CA 2004: pp. 276-286.
21. Yonezawa T, Onomura T, Kosaka R, et al. The system and procedures of percutaneous intradiscal laser nucleotomy. Spine 1990;15:1175-1185.
22. Chiu J, Clifford T, Greenspan M. Percutaneous microdecompressive endoscopic cervical discectomy with laser thermodiskoplasty. Mt Sinai J. of Med 2000;67:278-282.
23. Chiu J, Savitz M. Multicenter Study of Percutaneous Endoscopic Discectomy: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 94:p622-626.
24. Chiu, J., Savitz, MH. Use of Laser in Minimally Invasive Spinal Surgery and Pain Management. In: Kambin P, ed. Arthroscopic and Endoscopic Spinal Surgery - Text and Atlas. Second Edition. New Jersey: Humana Press; 2005: Chapter 13, pp 259-269.
25. Chiu J, Evolving Anterior Endoscopic Cervical Microdiscectomy with Laser Application for Spinal Motion Preservation, World Spine III: The Third Interdisciplinary Congress on Spine Care, Rio de Janeiro, Brazil, 7/31-8/3/2005, Proceedings: pp. 46.
26. Chiu J, Potential Complications of Minimally Invasive Spine Surgery and Their Avoidance: In; Khamlichi A, eds. Reprinted from 13th World Congress of Neurological Surgery, Marrakesh, 6/19-24/2005, International Proceedings, Medimond, Bologna, Italy, pp. 69-76.
27. Chiu J, Evolving Anterior Endoscopic Cervical Microdiscectomy with Laser Application for Spinal Motion Preservation, World Spine III: The Third Interdisciplinary Congress on Spine Care, Rio de Janeiro, Brazil, 7/31-8/3/2005, Proceedings: pp. 46.
28. Chiu J, Clifford T, Princenthal R. Junctional Disc Syndrome Following Fusion: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 80:p547-550.
29. Chiu J, Clifford T, Sison R. Lumbar Laser Microdiscectomy and Thermodiskoplasty: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 53:p402-408.
30. Chiu J, Savitz M. Multicenter Study of Percutaneous Endoscopic Discectomy: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 94:p622-626.
31. Chiu J, Yeung A, Lekht Z. Monitoring During Percutaneous Endoscopic Discectomy: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 90:p597-602.
32. Savitz M, Chiu J, Mogel G. Into the New Millennium and Beyond: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 100:p657-661.
33. Chiu J, Savitz M. Energy Sources for Tissue Modulation in Spinal Procedures: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 84:p563-566.
34. Chiu J, Junctional Disc Herniations in Post Spinal Fusion Treated with Endoscopic Spine Surgery for Segmental Motion Preservation, , World Spine III: The Third Interdisciplinary Congress on Spine Care, Rio de Janeiro, Brazil, 7/31-8/3/2005, Proceedings: pp. 68.
35. Chiu J, Yeung A, Savitz M. Potential Complications of Minimally Invasive Spinal Surgery: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 93:p615-621

Author Information

John C. Chiu, M.D., FRCS, D.Sc
Director, Neurospine Surgery, California Spine Institute Medical Center

Your free access to ISPUB is funded by the following advertisements:

Advertisement

 

Close

Enter the site

Login

Password

Remember me

Forgot password?

Login

SIGN IN AS A USER

Use your account on the social network Facebook, to create a profile on BusinessPress