Original Article

Cervical Endoscopic Discectomy

M Reuter

Citation

M Reuter. Cervical Endoscopic Discectomy. The Internet Journal of Minimally Invasive Spinal Technology. 2006 Volume 1 Number 1.

Abstract

Anterior approach for the cervical spine has been sought since the 19th century. Now minimally invasive (MI) surgical techniques have revolutionized the way spine surgeons treat herniated discs. Our MI anterior cervical discectomy (ACD) technique without fusion was performed on 396 patients who had mostly soft disc herniations - 160 males, 236 females (average age 41.5). Twenty nine of the 396 patients also had platelet gel after discectomy.

Selection criteria was based on symptoms consistent with radiologic findings for >3 months, discogram for difficult or multi-level cases & a favorable response to traction. Operating room (OR) instruments included discogram kit, fluoroscopy to confirm position, disc removal instruments, Holmium laser & LASE endoscopic catheter. OR set-up requires a radiolucent table, C-arm, X-ray & endoscopic monitors. Patients were placed in the supine position with cervical role, arms at side with wrist traction. Local anesthetic with I.V. sedation was required. With suction DRI about 1cc of disc was collected, 500-800 kilojoules used.

Average follow-up was 11.7 months with overall 88.4% good/ excellent results. Average surgical to discharge time was 3.2 hours. Operated levels included C3-4 to C7-T1 (C5-6 most common) with 313 initial single level & 88 initial multi-level discectomies. Three patients had complications; 1 patient had reaction to anesthesia twice & 2 patients had vascular complication needing emergent airway- hematoma evacuation without vascular repair. Overall, 9 patients had additional level discectomies, 14 patients went on for fusions at same level, 10 had prior fusions & 29 required revision surgery. Of the 29 sub-set platelet gel patients, they had a 96% good/excellent result. Four patients who required a revision had platelet gel added, one at an additional level.

Minimally Invasive Cervical Endoscopic Discectomy without fusion has a low complication rate, fast operative to discharge time and satisfactory functional results. And based on beneficial results with platelet gel, all patients received injection of platel gel since summer 2006.

 

References

1. Adamson TE: Microendoscopic posterior cervical laminoforaminotomy for unilateral Radiculopathy: results of a new technique in 100 cases. J Neurosurg 95(1 Suppl.):51-57, 2001.
2. Borenstein, DG, Wiesel, SW, Boden, SD: Clinical evaluation of neck and low back pain. In: Low Back and Neck Pain. Saunders, Philadelphia, PA. 2004.
3. Bucy PC, Heimburger RF, Oberhill HR: Compression of the cervical spinal cord by herniated intervertebral discs. J Neurosurg 5:471-492, 1948.
4. Chiu JC: Anterior endoscopic microdiscectomy. In: Endoscopic Spine Surgery and Instrumentation. Percutaneous Procedures (Kim DH, Fessler RG, Regan JJ eds). Thieme Medical Publishers, Inc., New York, 2005, pp. 48-58.
5. Chiu JC, Clifford TJ, Reuter MW: Cervical endoscopic discectomy with laser thermodiskoplasty. In: The Practice of Minimally Invasive Spinal Technique (Savitz MH, Chiu JC, Yeung AT eds). AAMISMS Education, LLC, Richmond, VA, 2000, pp. 141-148.
6. Chiu JC, Clifford TJ, Savitz MH, et. al: Multicenter study of percutaneous endoscopic discectomy (lumbar, cervical, and thoracic). J Minim Invasive Spinal Tech 1(1):33-37, 2001.
7. Chiu JC, Clifford TJ, Sison R: Anterior endoscopic cervical microdiscectomy. In: The Practice of Minimally Invasive Spinal Technique 2005 Edition (Savitz MH, Chiu JC, Rauschning W, Yeung AT eds-in-chief). AAMISS PRESS, New York, 2005, pp. 409-414.
8. Chiu JC, Clifford TJ, Sison R: Multiple herniated discs at single and multiple spinal segments treated with endoscopic microdecompressive surgery. J Minim Invasive Spinal Tech 2(1):15-16, 2002.
9. Chiu JC, Clifford TJ, Sison R, et. al: Junctional disc herniation syndrome following cervical fusion: Report of 4 cases treated by endoscopic laser surgery. J Minim Invasive Spinal Tech 4(1):53-55, 2004.
10. Cloward RB: Cervical diskography. Technique, indications and use in diagnosis of ruptured cervical disks. Amer J Roentgenol 70:563-574, 1958.
11. Cloward RB: The anterior approach for removal of ruptured cervical discs. J Neurosurg 15:602-617, 1958.
12. Coventry MB, Ghormley RK, Kernohan JW: The intervertebral disc: its microscopic anatomy and pathology. Part 11. Changes in the intervertebral disc concomitant with age. J Bone Joint Surg 27:460-474, 1945.
13. Coventry MB, Ghormley RK, Kernohan JW: The intervertebral disc: its microscopic anatomy and pathology. Part 1. Anatomy, development and physiology. J Bone Joint Surg 27:105-112, 1945.
14. Elsberg CA: The extradural ventral chondromas (ecchondroses), their favorite sites, the spinal cord and root symptoms they produce, and their surgical treatment. Bull Neurol Inst NY 1:350-388, 1931.
15. Elsberg CA: Tumors of the spinal cord and the symptoms of irritation and compression of the spinal cord and nerve roots; pathology, symptomatology, diagnosis and treatment. New York, PB Hoeber, pp. 421, 1925.
16. Fessler RG, Khoo LT: Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurg 51(5 Suppl):37-45, 2002.
17. Friedenberg ZB, Miller WT: Degenerative disc disease of the cervical spine: a comparative study of asymptomatic and symptomatic patients. J Bone Joint Surg 45A(6):1171-1178, 1963.
18. Frykholm R: Lower cervical vertebrae and intervertebral discs: surgical anatomy and pathology. Acta Chir Scand 101:345-359, 1951.
19. Hernandez-Carbajal B, Bravo-Bernabe PA, Gonzalez-Astudillo, G: Percutaneous cervical arthrodesis. J Minim Invasive Spinal Tech 4(1):38-39, 2004.
20. Hijikata S, Yamagishi M, Nakayama T, et al:. Percutaneous discectomy: a new treatment method of lumbar disc herniation. J Toden Hosp 5:5-13, 1977.
21. Hilibrand AS, Carlson GD, Palumbo MA, et al.: Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical athrodesis. J Bone Joint Surg 81-A:519-528, 1999.
22. Hoogland T, Scheckenbach C: Low-dose chemonucleolysis with percutaneous nulceotomy in herniated cervical disks. J Spinal Disord 8(3):228-232, 1995.
23. Hoppenfeld, S: Physical examination of the cervical spine and temporomandibular joint. In: Physical Examination of the Spine & Extremities. Appleton-Century-Crofts, 1976, pp. 120-124.
24. Jho HD, Kim WK, Kim MH: Anterior microforaminotomy for treatment of cervical radiculopathy: part 1-disc preserving "functional cervical disc surgery." Neurosurg 51(5 Suppl):46-53, 2002.
25. Jho HD: Failed anterior cervical foraminotomy. J Neurosurg (Spine 2); 98:121-125, 2003.
26. Kitagawa W, Shimizu K, Akasu H, et al.: Endoscopic neck surgery with lymph node dissection for papillary carcinoma of the thyroid using a totally gasless anterior neck skin lifting method. J Am Coll Surg 196(6):990-994, 2003.
27. Lee SH: Comparison of percutaneous endoscopic discectomy to open anterior discectomy for cervical herniations. J Minim Invasive Spinal Tech 1(1):17-19, 2001.
28. Lee SH: Percutaneous cervical discectomy with forceps and endoscopic Ho:YAG laser. In: Lasers in the Musculoskeletal System (Gerber BE, Knight M, Siebert WE, eds). Springer-Verlag, Berlin, Germany, 2001, pp. 292-302.
29. Lee SH, Yong A: Percutaneous endoscopic cervical discectomy and stabilization. In: Endoscopic Spine Surgery and Instrumentation. Percutaneous Procedures (Kim DH, Fessler RG, Regan JJ eds). Thieme Medical Publishers, Inc., New York, 2005, pp. 59-65.
30. Londonperfusionscience.com. http://www.londonperfusionscience.com.
31. Love JG, Camp JD: Root pain resulting from intraspinal protrusion of intervertebral discs. Diagnosis and surgical treatment. J Bone Joint Surg 19:776-804, 1937.
32. Murphey F, Simmons JC Brunson B: Surgical treatment of laterally ruptured cervical disc. J Neurosurg 38:679-683, 1973.
33. Patel CK, Fischgrund JS. Complications of anterior cervical spine surgery. Instr Course Lect 52:465-468, 2003.
34. Rao R: Neck pain, cervical radiculopathy, and cervical myelopathy: Pathophysiology, natural history, and clinical evaluation. Instr Course Lect 52:479-488, 2003.
35. Rao R: Neck pain, cervical radiculopathy, and cervical myelopathy: Pathophysiology, natural history, and clinical evaluation. In: Instructional Course Lectures Spine (An HS ed). American Academy of Orthopaedic Surgeons, Rosemont, Illinois, 2003, pp. 5-14.
36. Reuter MW: Cervical laser assisted spinal Endoscopy. In: The Practice of Minimally Invasive Spinal Technique 2005 Edition (Savitz MH, Chiu JC, Rauschning W, Yeung AT eds-in-chief). AAMISMS PRESS, New York, 2005, pp. 428-431.
37. Reuter MW, Alvarado J, Anger DM: Cervical Nucleoplasty. In: The Practice of Minimally Invasive Spinal Technique 2005 Edition (Savitz MH, Chiu JC, Rauschning W, Yeung AT eds-in-chief). AAMISMS PRESS, New York, 2005, pp. 368-372.
38. Reuter MW, Anger DM: Laser assisted spinal endoscopy for herniated cervical discs. J Minim Invasive Spinal Tech 2(1):17-19, 2002.
39. Reuter MW, Mikulinsky AE, Anger DM: Anterior cervical discectomy with the LASE system. J Minim Invasive Spinal Tech 1(1):24-25, 2001.
40. Reuter MW, Reuter GL, Rehder CD: Method and device for treating intervertebral disc herniations. US Patent no 20,030,069,641. 2003.
41. Richard Wolf Medical Instruments Corporation: Endoscopic Spine Surgery System for Spinal Decompression. http://www.richardwolfusa.com. 2003.
42. Sawin PD, Traynelis VC, Menezes AH: A comparative analysis of fusion rates and donor-site morbidity for autogeneic rib and iliac crest bone grafts in posterior cervical fusions. J Neurosurg 88:225-265, 1998.
43. Sonntag VKH, Klara P: Controversy in spine care. Is fusion necessary after anterior cervical discectomy? Spine 21:1111-1113, 1996.
44. Stookey B: Compression of spinal cord and nerve roots by herniation of the nucleus pulposus in the cervical regions. Arch Surg 40:417-432, 1940.
45. White AA, Panjabi MM: Kinematics of the spine. In: Clinical Biomechanics of the Spine (White AA, Panjabi MM, eds), JB Lippincott, Philadelphia, PA, pp. 86-125, 1990.
46. Wigfield CC, Nelson RJ: Nonautologous interbody fusion materials in cervical spine surgery: how strong is the evidence to justify their use? Spine 26:687-694, 2001.
47. Wood GW: Lower back pain and disorders of intervertebral disc. In: Campbell's Operative Orthopaedics (Crenshaw AH ed). The CV Mosby Company, St. Louis, Missouri, 1987, p. 3279.
48. Ylinen J, Takala EP, Nykamen M, et al.: Active neck muscle training in the treatment of chronic neck pain in women-a randomized controlled trial. JAMA 289:2509-2516, 2003.
49. Yong A, Lee SH: Percutaneous endoscopic cervical fusion with expandable holder: case reports of initial technique. J Minim Invasive Spinal Tech 2(1):8-9, 2002.

Author Information

Merrill W. Reuter, M.D., Ph.D.

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

Advertisement