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Zhang P, Jin Y, Zhu B, Zheng M, Ying X, Zheng Q. Unilateral biportal endoscopic foraminotomy and diskectomy combined with piezosurgery for treating cervical spondylotic radiculopathy with neuropathic radicular pain. Front Neurol 2023; 14:1100641. [PMID: 37114218 PMCID: PMC10126746 DOI: 10.3389/fneur.2023.1100641] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 02/14/2023] [Indexed: 04/29/2023] Open
Abstract
Objective Unilateral biportal endoscopy (UBE) represents a relatively recent development in minimally invasive spine surgery. This study aimed to evaluate the efficacy and safety of UBE foraminotomy and diskectomy combined with piezosurgery for treating cervical spondylotic radiculopathy (CSR) with neuropathic radicular pain. Methods We retrospectively analyzed the outcomes in 12 patients with CSR who underwent UBE foraminotomy and diskectomy combined with piezosurgery. The intraoperative blood loss, operative time, visual analog scale (VAS) scores for the neck and arm, neck disability index (NDI) scores, and complications were recorded. Results Postoperative VAS scores of the neck and arm and NDI scores were significantly improved. Additionally, a postoperative CT scan revealed adequate enlargement of the cervical canal and nerve root. No specific complications occurred during surgery and the immediate postoperative period. Conclusions This primary study indicated that the UBE foraminotomy and diskectomy with piezosurgery is a promising technique for treating cervical spondylotic radiculopathy with neuropathic radicular pain.
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Zhang J, Zhou Q, Yan Y, Ren J, Wei S, Zhu H, Song Z. Efficacy and safety of percutaneous endoscopic cervical discectomy for cervical disc herniation: a systematic review and meta-analysis. J Orthop Surg Res 2022; 17:519. [PMID: 36456964 PMCID: PMC9714009 DOI: 10.1186/s13018-022-03365-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Accepted: 10/18/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Since there are currently no systematic evidence-based medical data on the efficacy and safety of PECD, this meta-analysis pooled data from studies that reported the efficacy or safety of PECD for cervical disc herniation to examine the efficacy, recurrence and safety of using PECD to treat cervical disc herniation. METHODS We searched the PubMed, EMBASE and Cochrane Library databases for studies published from inception to July 2022. Nine nonrandomized controlled trials (non-RCTs) that reported the efficacy or safety of percutaneous endoscopic cervical discectomy for cervical disc herniation were included. We excluded duplicate publications, studies without full text, studies with incomplete information, studies that did not enable us to conduct data extraction, animal experiments and reviews. STATA 15.1 software was used to analyse the data. RESULTS The proportions of excellent and good treatment results after PECD for CDH were 39% (95% CI: 31-48%) and 47% (95% CI: 34-59%), respectively. The pooled results showed that the VAS scores at 1 week post-operatively (SMD = -2.55, 95% CI: - 3.25 to - 1.85) and at the last follow-up (SMD = - 4.30, 95% CI: - 5.61 to - 3.00) after PECD for cervical disc herniation were significantly lower than the pre-operative scores. The recurrence rate of neck pain and the incidence of adverse events after PECD for cervical disc herniation were 3% (95% CI: 1-6%) and 5% (95% CI: 2-9%), respectively. Additionally, pooled results show that the operative time (SMD = - 3.22, 95% CI: - 5.21 to - 1.43) and hospital stay (SMD = - 1.75, 95% CI: - 2.67to - 0.84) were all significantly lower for PECD than for ACDF. The pooled results also showed that the proportion of excellent treatment results was significantly higher for PECD than for ACDF (OR = 2.29, 95% CI: 1.06-4.96). CONCLUSION PECD has a high success rate in the treatment of CHD and can relieve neck pain, and the recurrence rate and the incidence of adverse events are low. In addition, compared with ACDF, PECD has a higher rate of excellent outcomes and a lower operative time and hospital stay. PECD may be a better option for treating CHD.
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Affiliation(s)
- Jinjie Zhang
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
| | - Qiujun Zhou
- grid.268505.c0000 0000 8744 8924Department of First Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, 310000 China
| | - Yan Yan
- grid.24695.3c0000 0001 1431 9176The Third Affiliated Hospital of Beijing University of Chinese Medicine, No. 51 Anwai Xiaoguanjie, Chaoyang District, Beijing, 100029 China
| | - Jianlei Ren
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
| | - Shenyu Wei
- grid.412465.0Department of Hepato-Pancreato-Biliary Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Zhejiang, 310000 China
| | - Haijia Zhu
- grid.507982.10000 0004 1758 1016Hangzhou Children’s Hospital, Hangzhou, 310000 China
| | - Zhoufeng Song
- grid.417400.60000 0004 1799 0055The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine), 54 Post and Telegraph Road Uptown, Hangzhou, 310000 China
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Jung SB, Kim N. Biportal endoscopic spine surgery for cervical disk herniation: A technical notes and preliminary report. Medicine (Baltimore) 2022; 101:e29751. [PMID: 35801784 PMCID: PMC9259155 DOI: 10.1097/md.0000000000029751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Biportal endoscopic spine surgery (BESS) for cervical disk herniation (CDH) has been rarely reported. The aim of the article is to describe a novel BESS as a posterior approach for CDH and report the preliminary outcomes and complications. This single-centered retrospective chart review included 109 consecutive patients who underwent BESS for symptomatic single-level CDH. Working and viewing portals were created in each unilateral paravertebral area at the target disk level. Endoscopic exploration allowed for effective and minimally invasive decompression via safe access to the medial foramen with minimal laminectomy and facetectomy. Clinical outcomes, including the visual analog scale, neck disability index, Macnab criteria, and the motor function of the involved arm, were evaluated at 4, 8, 12, and 24 postoperative weeks. Visual analog scale and neck disability index improved significantly at 24 weeks postoperatively (P < .01). According to the Macnab criteria, "excellent," "good," and "fair" results were obtained for 55.9%, 30.3%, and 13.8% of patients, respectively. The post 24-week distribution of the involved upper extremity strength grade was significantly improved compared to the initial value (P = .02). One patient had a motor weakness with a decreased grade over 4 weeks from excessive irrigation. The posterior approach of BESS was efficient and feasible for the treatment of CDH.
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Affiliation(s)
- Seok Bong Jung
- Spine Center, Jinju Bon Hospital, Jinju-si, Gyeongsangnam-do, Republic of Korea
| | - Nackhwan Kim
- Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, Ansan-si, Gyeonggi-do, Republic of Korea
- *Correspondence: Nackhwan Kim, Department of Physical Medicine and Rehabilitation, Korea University Ansan Hospital, 15355, Jeokgeum-Ro 123, Danwon-gu, Ansan-si, Gyeonggi-do, Republic of Korea (e-mail: )
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Ahn Y. The Current State of Cervical Endoscopic Spine Surgery: an Updated Literature Review and Technical Considerations. Expert Rev Med Devices 2020; 17:1285-1292. [PMID: 33210554 DOI: 10.1080/17434440.2020.1853523] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Introduction: Endoscopic spine surgery has become one of the representative minimally invasive spine surgeries (MISS), especially in the lumbar spine. Full-endoscopic procedures using a working channel endoscope for cervical degenerative spine disease have been reported as practical and feasible. This review aimed to summarize the updated techniques of and studies about cervical endoscopic surgery. Areas covered: An extensive search of PubMed was performed for randomized controlled trials (RCTs) or comparative cohort studies on the full-endoscopic cervical procedure. All the 236 articles found were screened and categorized. Only two RCTs and four cohort studies finally met the search criteria. Regarding the surgical techniques, there are four categories according to the approach method: 1) anterior endoscopic cervical discectomy (AECD); 2) anterior endoscopic cervical transcorporeal decompression (AECTcD); 3) posterior endoscopic cervical foraminotomy and discectomy (PECFD); and 4) posterior endoscopic cervical laminotomy (PECL). Expert opinion: Cervical endoscopic surgery provides comparable clinical results with MISS benefits, such as shorter operative time, less bleeding, and earlier recovery time. However, spine surgeons are not yet familiar with most of these techniques; moreover, supportive evidence is minimal. Technical evolution is still ongoing in an effort to make the procedure more practical.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine , Incheon, South Korea
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Kim HS, Wu PH, Jang IT. Current and Future of Endoscopic Spine Surgery: What are the Common Procedures we Have Now and What Lies Ahead? World Neurosurg 2020; 140:642-653. [PMID: 32797991 DOI: 10.1016/j.wneu.2020.03.111] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 03/17/2020] [Accepted: 03/18/2020] [Indexed: 11/18/2022]
Abstract
The aging population around the world leads to increasing incidence of degenerative spinal conditions. There is a need for a minimally invasive technique in treatment for spinal conditions to meet the medical complexity and comorbidities that comes with aging. Principles of endoscopy are similar to minimally invasive surgery, which is to decrease pressure on soft tissue crushing from prolonged retraction, avoid soft tissue stripping and dissection, and bone and ligamentous preservation for optimal decompression without excessive destruction. Endoscopic spine surgery techniques started slowly in development in the 1970s to 2000s, with a rapid phase of development since the turn of the 21st century with endoscopic solutions developing in cervical, thoracic, and lumbar conditions with increasing complexity in nature of operation. Technological enhancement with progressively supportive literature is pushing boundaries of endoscopy from the early days of soft tissue procedure to current fusion procedures, endoscopic spine surgery techniques is covering more areas of spine than ever previously possible with good clinical results. We present a review on the current techniques available and postulated near future development for endoscopic spine surgery.
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Affiliation(s)
- Hyeun Sung Kim
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea.
| | - Pang Hung Wu
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea; Department of Orthopaedic Surgery, National University Health System, Jurong Health Campus, Singapore
| | - Il-Tae Jang
- Department of Spine Surgery, Nanoori Gangnam Hospital, Seoul, Republic of South Korea
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Ahn Y. A Historical Review of Endoscopic Spinal Discectomy. World Neurosurg 2020; 145:591-596. [PMID: 32781148 DOI: 10.1016/j.wneu.2020.08.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Revised: 07/29/2020] [Accepted: 08/01/2020] [Indexed: 12/23/2022]
Abstract
As an essential component of minimally invasive spine surgery, endoscopic spine surgery (ESS) has continuously evolved and has been accepted as a practical procedure by the worldwide spine community. Especially for lumbar disc herniation (LDH), the percutaneous endoscopic or full-endoscopic discectomy technique has been scientifically proven through randomized controlled trials and meta-analyses to be a good alternative to open discectomy. The initial concept of endoscopic spine discectomy was concerned with indirect disc decompression using various instruments such as blind forceps, a nucleotome, laser, radiofrequency coblation, and some chemical agents. The main surgical field has been shifted from the intradiscal space to the epidural space. Precise and selective discectomy for extruded LDH in the epidural space under high-quality endoscopic visualization is now feasible. Furthermore, the medical applications of ESS is broadening to include spinal stenosis, segmental instability, infection, and even intradural lesions. In this review article, I describe the history of endoscopic spine discectomy and decompression techniques, as well as evolution of the paradigm. This history may help indicate the future of practical ESS.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea.
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Percutaneous Endoscopic Cervical Discectomy Versus Anterior Cervical Discectomy and Fusion: A Comparative Cohort Study with a Five-Year Follow-Up. J Clin Med 2020; 9:jcm9020371. [PMID: 32013206 PMCID: PMC7073710 DOI: 10.3390/jcm9020371] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 01/26/2020] [Indexed: 11/16/2022] Open
Abstract
Percutaneous endoscopic cervical discectomy (PECD) is an effective minimally invasive surgery for soft cervical disc herniation in properly selected cases. The current gold standard is anterior cervical discectomy and fusion (ACDF). However, few studies have evaluated the outcome of PECD compared with ACDF. We compared the surgical results of PECD and ACDF. Data from patients treated with single-level PECD (n = 51) or ACDF (n = 64) were analyzed. Patients were prospectively entered into the clinical database and their records were retrospectively reviewed. Perioperative data and clinical outcomes were evaluated using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Macnab criteria. VAS and NDI results significantly improved in both groups. The rates of excellent or good results were 88.24% and 90.63% in the PECD and ACDF group, respectively. The revision rates were 3.92% and 1.56% in the PECD and ACDF group, respectively. Operative time, hospital stay, and time to return to work were reduced in the PECD group compared to the ACDF group (p < 0.001). The five-year outcomes of PECD were comparable to those of conventional ACDF. PECD provided the typical benefits of minimally invasive surgery and may be an effective alternative for treating soft cervical disc herniation.
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Bucknall V, Gibson JA. Cervical endoscopic spinal surgery: A review of the current literature. J Orthop Surg (Hong Kong) 2019; 26:2309499018758520. [PMID: 29455630 DOI: 10.1177/2309499018758520] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Cervical endoscopic spinal surgery (CESS) is now regularly performed in some centres in the Far East, yet rarely in Europe and the United States. This review describes the application of CESS through anterior and posterior approaches with analysis of the available evidence supporting current techniques. An electronic literature search identified 52 papers and proceedings' abstracts of which 25 (16 anterior approach and 9 posterior approach) provided comparable clinical outcomes. The results revealed a good or excellent outcome from CESS in 91% (range 74-100%) with a complication rate of 5%. In a local cohort study, patients had 72% less neck pain (visual analogue scale rating) and 81% less arm pain at 6 months when CESS was used as an isolated procedure, and 74% less neck pain and 83% less arm pain when coupled with disc replacement or fusion at an adjacent level.
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Affiliation(s)
- Vittoria Bucknall
- The Royal Infirmary and University of Edinburgh, Little France, Edinburgh, UK
| | - Jn Alastair Gibson
- The Royal Infirmary and University of Edinburgh, Little France, Edinburgh, UK
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9
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Endoscopic spine discectomy: indications and outcomes. INTERNATIONAL ORTHOPAEDICS 2019; 43:909-916. [DOI: 10.1007/s00264-018-04283-w] [Citation(s) in RCA: 63] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 12/26/2018] [Indexed: 02/07/2023]
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Minimally invasive anterior cervical discectomy and fusion: a valid alternative to open techniques. Acta Neurochir (Wien) 2018; 160:2467-2471. [PMID: 30417202 DOI: 10.1007/s00701-018-3719-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 10/27/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Anterior cervical discectomy and fusion (ACDF) is a well-standardized treatment for cervical myelopathy/radiculopathy. The aim of this study is to assess the feasibility of minimally invasive ACDF. METHOD Retrospective review of six patients who underwent minimally invasive ACDF using microscope and tubular retractors. Clinical and radiological outcomes and surgical complications were reviewed. CONCLUSION Minimally invasive microscopic ACDF through tubular retractors is a feasible option and therefore an alternative to conventional open procedures. However, it does require advanced technical skills and good understanding of the MIS principles and limitations of the technique.
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Quillo-Olvera J, Lin GX, Kim JS. Percutaneous endoscopic cervical discectomy: a technical review. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:100. [PMID: 29707549 DOI: 10.21037/atm.2018.02.09] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The treatment of cervical disc herniations has evolved in the last 2 decades. While the anterior cervical discectomy and fusion continues being the gold standard for the treatment of radicular pain triggered by cervical disc herniation, other surgical approaches have been developed. Percutaneous endoscopic cervical discectomy has demonstrated the ability to decompress the exiting nerve root and dural sac correctly and encouraging clinical outcomes has been reported in the literature. One of the most important advantages offered by the endoscopic technique is the capability to resolve the patient's symptoms without the need for interbody fusion. Also, a specific and selective decompression under continuous visualization with minimal surgery-related trauma can be achieved. There are two percutaneous endoscopic cervical discectomy approaches: anterior and posterior. The decision to perform each other depends on pathology site. However, the endoscopic technique requires previous surgical training, a steep learning curve, and proper patient selection. The development of new hardware such as endoscopes with better optics, lighting systems, and endoscopic surgical tools have allowed using endoscopic techniques in more complex cases. The objective of this review is the technical description of the anterior and posterior percutaneous endoscopic cervical discectomy.
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Affiliation(s)
- Javier Quillo-Olvera
- Department of Neurosurgery, Spine Center, Seoul St. Mary's Hospital, College of Medicine. The Catholic University of Korea, Seoul, South Korea
| | - Guang-Xun Lin
- Department of Neurosurgery, Spine Center, Seoul St. Mary's Hospital, College of Medicine. The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, Spine Center, Seoul St. Mary's Hospital, College of Medicine. The Catholic University of Korea, Seoul, South Korea
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Effective Range of Percutaneous Posterior Full-Endoscopic Paramedian Cervical Disc Herniation Discectomy and Indications for Patient Selection. BIOMED RESEARCH INTERNATIONAL 2017; 2017:3610385. [PMID: 29226132 PMCID: PMC5684516 DOI: 10.1155/2017/3610385] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Revised: 08/13/2017] [Accepted: 08/15/2017] [Indexed: 11/17/2022]
Abstract
The objective was to investigate the effective and safe range of paramedian CDH by percutaneous posterior full-endoscopy cervical intervertebral disc nucleus pulposus resection (PPFECD) to provide a reference for indications and patient selection. Sixteen patients with CDH satisfied the inclusion criteria. Before surgery the patients underwent cervical spine MRI, and the distance between the dural sac and herniated disc was measured. An assessment was performed by MRI immediately after surgery, measuring the distance between dural sac and medial border of discectomy (DSMD). The preoperative average distance between the dural sac and peak of the herniated disc (DSPHD) was 3.87 ± 1.32 mm; preoperative average distance between dural sac and medial border of herniated disc (DSMHD) was 6.91 ± 1.21 mm and an average distance of postoperative DSMD was 5.41 ± 1.40 mm. Postoperative VAS of neck and shoulder pain was significantly decreased but JOA was significantly increased in each time point compared with preoperative ones. In summary, the effective range of PPFECD to treat paramedian CDH was 5.41 ± 1.40 mm, indicating that DSMHD and DSPHD were within 6.91 ± 1.21 mm and 3.87 ± 1.32 mm, respectively. PPFECD surgery is, therefore, a safe and effective treatment option for patients with partial paramedian cervical disc herniation.
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Percutaneous Endoscopic Cervical Discectomy (PECD): An Analysis of Outcome, Causes of Reoperation. World Neurosurg 2017; 102:583-592. [DOI: 10.1016/j.wneu.2017.03.056] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/13/2017] [Accepted: 03/14/2017] [Indexed: 11/17/2022]
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Abstract
Percutaneous endoscopic cervical discectomy has evolved as an efficient, minimally invasive spine surgery for cervical disc herniation or radiculopathy. The development of the working channel endoscope makes definitive decompression surgery through a percutaneous approach feasible. There are two methods of approach to target the pathology: anterior and posterior approach. The approach can be determined according to the zone of pathology or the surgeon's preference. The most significant benefits of this endoscopic surgical technique are minimal access tissue trauma and early recovery from the intervention. However, this technique is still evolving and have a steep learning curve. Extensive development of surgical technique and working channel endoscopes will enable us to treat cervical disc herniation more practically. The objective of this review is to describe the cutting-edge techniques of endoscopic surgery in the cervical spine and to discuss the pros and cons of these minimally invasive surgical techniques.
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Affiliation(s)
- Yong Ahn
- a Department of Neurosurgery , Nanoori Hospital , Seoul , Republic of Korea
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15
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Abstract
STUDY DESIGN A retrospective review series. OBJECTIVE To identify vascular anatomy and esophageal deviations that may interfere with a percutaneous anterior approach in cervical spine surgery. SUMMARY OF BACKGROUND DATA The percutaneous anterior approach has been used for minimally invasive interventions of cervical disc diseases. Although the percutaneous anterior approach is frequently performed, reports of obstructing anatomical structures and procedural risks are limited. METHODS Cervical magnetic resonance images obtained from December 2012 to April 2013 from a total of 511 patients at Guro Teun Teun Hospital were evaluated in this study. Each axial T2-weighted MR image from the disc levels of C3-C4 to C6-C7 (total, 3066 images) was reviewed to check for the presence of small vessels along the trajectories of percutaneous cervical procedures on the left and right sides. Esophageal deviation was also measured at level C6-C7. RESULTS Small vessels in the anterior neck were present, respectively, in 50.5% (trajectory on the left side) and in 49.1% (trajectory on the right side) at disc level C3-C4, in 30.3% and 28.8% at C4-C5, in 24.1% and 7.6% at C5-C6, and in 55.2% and 43.1% at C6-C7. There were no differences in the number of small vessels between the left and right sides at the upper cervical level (C3-C4-C5), but small vessels were less frequently observed on the right side at lower cervical levels (C5-C6-C7). Differences in esophageal deviation were also observed, with less deviation to the right side (0.63 ± 0.35 cm) than the left (1.18 ± 0.52 cm). As well, an esophageal diverticulum was observed in 1 case on the left side. CONCLUSION Although surgical approaches are mostly concerned with the location of pathology to be removed, a right-sided percutaneous approach seems preferable because poses less of a risk of encountering small vessels and causing esophageal injury. LEVEL OF EVIDENCE 4.
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Choi G, Lee SH, Carvalho MFD, Prada N. Percutaneous endoscopic cervical discectomy: 16 years of experience and literature review. COLUNA/COLUMNA 2009. [DOI: 10.1590/s1808-18512009000300017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
The advancement of the percutaneous endoscopic lumbar discectomy (PECD) and its clinical success have led to similar minimally invasive approaches to the cervical spine. The goal of PECD is the decompression of the cervical nerve root through a direct endoscopic visualization, removing the herniated mass and shrinking the nucleous pulposus with the use of microforceps and holmium: yttrium-aluminum-garnet (Ho:YAG) laser. The senior author have performed PECD with cervical laser assisted endoscopy since 1993. The PECD is indicate to patients with constrained or unconstrained soft herniated cervical disc, positive provocative test, and no bony spur larger than 2 mm, regardless of the herniation size. The authors described the surgical technique of PECD and report their 16 years of experience in the endoscopic treatment of the herniated cervical disc.
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Affiliation(s)
- Gun Choi
- Wooridul Spine Hospital, South Korea
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Lee SH, Lee JH, Choi WC, Jung B, Mehta R. Anterior minimally invasive approaches for the cervical spine. Orthop Clin North Am 2007; 38:327-37; abstract v. [PMID: 17629981 DOI: 10.1016/j.ocl.2007.02.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The percutaneous endoscopic discectomy (PECD) with working channel endoscope (WSH) endoscopy set could be a safe and effective minimally invasive surgical option for non-contained cervical disc herniation in selected patients. Judicious use of the end-firing Ho: Yttrium-Aluminium-Garnet (YAG) laser for both decompressive and thermoannuloplasty effect during the percutaneous endoscopic cervical annuloplasty (PECA) is mandatory in order to prevent possible injury to spinal cord or root. Although the percutaneous cervical stabilization (PCS) using the cervical B-Twin may not completely replace the cervical arthrodesis, this minimally invasive procedure can preserve anterior structures and thereby retain segmental stability and prevent the possible kyphotic progression after fusion surgery. To our knowledge, these minimally invasive procedures for cervical spine disease may serve to minimize surgery-induced complications associated with anterior cervical discectomy and fusion (ACDF).
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Affiliation(s)
- Sang-Ho Lee
- Department of Neurosurgery, Wooridul Spine Hospital, Gangnam-Gu, Seoul, Korea.
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Jo D, Kim S, Kim M. Percutaneous Cervical Discectomy using Dekompressor® to the Patient with Posterolateral Extrusion Disc -A case report-. Korean J Pain 2006. [DOI: 10.3344/kjp.2006.19.2.253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Daehyun Jo
- Pain Clinic, CHA General Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Sangjin Kim
- Pain Clinic, CHA General Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
| | - Myounghee Kim
- Department of Anesthesiology, CHA General Hospital, College of Medicine, Pochon CHA University, Seongnam, Korea
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Ahn Y, Lee SH, Shin SW. Percutaneous endoscopic cervical discectomy: clinical outcome and radiographic changes. Photomed Laser Surg 2005; 23:362-8. [PMID: 16144477 DOI: 10.1089/pho.2005.23.362] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the clinical outcome and radiographic changes of percutaneous endoscopic cervical discectomy (PECD) with the high-resolution working channel endoscope. BACKGROUND DATA Percutaneous disc decompression using a laser and/or microforceps for cervical disc herniation has been regarded as an effective treatment modality in selected cases. However, the postoperative radiographic changes have not yet been evaluated. METHODS We reviewed the clinical and radiographic records of 36 consecutive patients who underwent PECD with the working channel endoscope. The herniated discs were selectively removed by Ho:YAG laser and microforceps under high-resolution endoscopic visualization. The postoperative radiographic changes, including the disc height, the sagittal cervical alignment, and the segmental range of motion were measured. RESULTS The mean follow-up period was 28.6 months (range, 23-34 months). Based on the Prolo Scale, excellent outcomes were achieved in 19 of 36 patients (52.8%), good outcomes in 12 (33.3%), fair outcomes in three (8.3%), and poor outcomes in two (5.6%). The disc height significantly decreased by 11.2% of the original height (p < 0.001). However, the overall and focal sagittal alignments were well maintained. There was no segmental instability or spontaneous fusion. One patient required subsequent open surgery due to incomplete decompression. CONCLUSIONS The high-resolution working channel endoscope allowed us to selectively remove the cervical herniated disc. The postoperative disc height reduction was observed, with no significant effect on therapeutic success. The sagittal alignment and segmental motion were well preserved.
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Affiliation(s)
- Yong Ahn
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, Korea.
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Ahn Y, Lee SH, Lee SC, Shin SW, Chung SE. Factors predicting excellent outcome of percutaneous cervical discectomy: analysis of 111 consecutive cases. Neuroradiology 2004; 46:378-84. [PMID: 15103434 DOI: 10.1007/s00234-004-1197-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2004] [Accepted: 03/06/2004] [Indexed: 10/26/2022]
Abstract
Percutaneous cervical discectomy (PCD) has been developed as an effective treatment option for soft cervical disc herniation. However, no prognostic study of this procedure has yet been made. The purpose of this study was to evaluate the surgical outcome of PCD and to determine the factors predicting excellent outcome. A retrospective review was performed of 111 consecutive patients who underwent PCD with a mean follow-up period of 49.4 months (range, 29-64 months). Under local anesthesia, a percutaneous anterior approach was followed by discectomy with microforceps and endoscopic Ho:YAG laser. The surgical outcomes of the 111 patients based on the Macnab criteria were excellent in 52 patients (46.9%), good in 37 (33.3%), fair in 9 (8.1%), and poor in 13 (11.7%), thereby indicating a symptomatic improvement in 88.3% of the patients. In this study, the two major factors predicting an excellent long-term outcome were the symptom of radiating arm pain (P = 0.02) and the location of lateral disc herniation (P < 0.02). Proper patient selection remains critical for the success of this minimally invasive procedure.
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Affiliation(s)
- Y Ahn
- Department of Neurosurgery, Wooridul Spine Hospital, 47-4 Chungdam-dong Kangnam-gu, 135-100 Seoul, Korea
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