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Ishibashi K, Yanagisawa K, Tominaga R, Inomata Y, Takebayashi K, Mizutani T, Iwai H, Koga H. Posterior endoscopic cervical discectomy with partial pediculotomy for management of highly down-migrated cervical disc herniation: A case report. Surg Neurol Int 2025; 16:75. [PMID: 40041088 PMCID: PMC11878669 DOI: 10.25259/sni_990_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2024] [Accepted: 01/29/2025] [Indexed: 03/06/2025] Open
Abstract
Background Highly migrated cervical disc herniations are rare, and the optimal surgical approach remains uncertain. When located in the median or paramedian position, anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion are preferentially selected, whereas posterior approaches are often considered for cases with radiculopathy. Case Description A 40-year-old woman presented with right C6 radicular symptoms without any specific triggering event. She initially experienced symptom relief through medication and an ultrasound-guided nerve block 4 years previously. The symptoms recurred 2 months before presentation and did not improve with conservative treatment. Magnetic resonance imaging revealed a paramedian herniation on the right side, migrating downward from the C5/6-disc level to the inferior border of the pedicle. Posterior endoscopic cervical discectomy (PECD) with partial pediculotomy was performed under general anesthesia with transcranial motor-evoked potential monitoring. The operative time was 56 min. The patient experienced immediate symptom relief, mobilized 3 h postoperatively, and was discharged the following day. Conclusion PECD with partial pediculotomy is a minimally invasive and effective option for treating highly down-migrated cervical disc herniation, offering reduced tissue disruption, faster recovery, and excellent clinical outcomes.
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Affiliation(s)
| | | | - Ryoji Tominaga
- Department of Orthopedic, Iwai Orthopaedic Hospital, Tokyo, Japan
| | - Yasushi Inomata
- Department of Orthopedic, Iwai Orthopaedic Hospital, Tokyo, Japan
| | | | - Takashi Mizutani
- Department of Orthopedic, Iwai Orthopaedic Hospital, Tokyo, Japan
| | - Hiroki Iwai
- Department of Orthopedic, Iwai Orthopaedic Hospital, Tokyo, Japan
| | - Hisashi Koga
- Department of Neurosurgery, Iwai Full-Endoscopic Spine Surgery (FESS) Clinic, Tokyo, Japan
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Liu Y, Suvithayasiri S, Van Isseldyk F, Kotheeranurak V, Jitpakdee K, Choi KC, Choi G, Bae J, Kim JS. Evaluating the effectiveness of the transcorporeal approach in minimally invasive spine surgery for cervical spinal disease: a comprehensive review and technical insights. BMC Surg 2024; 24:311. [PMID: 39407285 PMCID: PMC11481767 DOI: 10.1186/s12893-024-02611-z] [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] [Subscribe] [Scholar Register] [Received: 07/26/2024] [Accepted: 10/03/2024] [Indexed: 10/19/2024] Open
Abstract
BACKGROUND The evolution of minimally invasive spine surgery, propelled by microscopy and endoscopy techniques, has reshaped the landscape of spinal interventions. The anterior approach to the cervical spine is widely recognized for its reproducibility and effectiveness in treating pathologies leading to radiculopathy or myelopathy. Apart from the traditional transdiscal approach, this study delves into the anterior transcorporeal approach, a minimally invasive technique, exploring its applicability in various cervical spinal pathologies. PURPOSE The objective is to comprehensively illustrate the anterior transcorporeal approach, exploring its historical development, biomechanical underpinnings, technical nuances, and clinical applications in managing cervical spine disorders. METHODS We conducted a comprehensive review using PubMed, Embase, Cochrane Library, and Web of Science, adhering to PRISMA guidelines. The search was focused on the minimally invasive anterior transcorporeal approach for cervical pathologies, with an emphasis on evaluating the methodological evolution, technical execution, and clinical outcomes across diverse studies. RESULTS The review identified a significant body of literature supporting the efficacy of the minimally invasive anterior transcorporeal approach. Over the past two decades, this approach has demonstrated encouraging clinical outcomes, suggesting its potential as an alternative strategy for specific cervical spine diseases. The evolution of this technique is tightly linked to the advancements in medical equipment and the innovative endeavors of surgical pioneers. CONCLUSIONS The anterior transcorporeal approach marks a milestone in minimally invasive cervical spine surgery. Its development reflects ongoing efforts to refine surgical techniques for better patient outcomes. While offering a promising alternative for treating certain cervical spine conditions, the approach demands precise case selection and is influenced by the rapid progression of medical technology. Future research and technological advancements are expected to further enhance the efficacy and safety of this approach, potentially expanding its indications in spinal surgery.
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Affiliation(s)
- Yanting Liu
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Siravich Suvithayasiri
- Department of Orthopedics, Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand
- Bone and Joint Excellence Center, Thonburi Hospital, Bangkok, Thailand
| | - Facundo Van Isseldyk
- Latinamerican Endoscopic Spine Surgery Society, Hospital Privado de Rosario, Argentina, Rosario
| | - Vit Kotheeranurak
- Department of Orthopaedics, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Khanathip Jitpakdee
- Department of Orthopedics, Thai Red Cross Society, Queen Savang Vadhana Memorial Hospital, Bangkok, Thailand
| | - Kyung-Chul Choi
- Department of Neurosurgery, Seoul Top Spine Hospital, Goyangsi, South Korea
| | - Gun Choi
- Neurosurgeon/Spine Surgeon and Medical Director, Pohang Woori Hospital, Pohang, South Korea
| | - Junseok Bae
- Department of Neurosurgery, Wooridul Spine Hospital, Seoul, South Korea
| | - Jin-Sung Kim
- Department of Neurosurgery, College of Medicine, Seoul St. Mary's Hospital, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Andreão FF, Maia M, Sousa MP, Mancilha MDS, de Barros Oliveira L, Quadros DG, Serra MV. Letter to the Editor Regarding "Anterior Percutaneous Full-Endoscopic Transcorporeal with Single-Incision Treatment for Noncontiguous 2-Level Cervical Disc Herniation: Technical Report and Early Follow-Up". World Neurosurg 2024; 185:459-460. [PMID: 38741302 DOI: 10.1016/j.wneu.2024.02.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 02/09/2024] [Indexed: 05/16/2024]
Affiliation(s)
- Filipi Fim Andreão
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
| | - Matheus Maia
- State University of Pará, Santarém, Para, Brazil
| | - Marcelo Porto Sousa
- Federal University of Rio de Janeiro, Rio de Janeiro, Rio de Janeiro, Brazil
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Jitpakdee K, Kotheeranurak V, Lim WJ, Kim JS. Anterior Transcorporeal Approach for Cervical Metastatic Melanoma Resection Guided by O-Arm-Navigated Intraoperative Computed Tomography. Oper Neurosurg (Hagerstown) 2022; 22:e7-e11. [PMID: 34982904 DOI: 10.1227/ons.0000000000000014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Surgical resection of the ventrally located tumor in the cervical spinal region is technically challenging and usually requires a traditional extensive approach. To reduce collateral injury and preserve cervical stability, the anterior transcorporeal approach under navigated guidance is an alternative minimally invasive technique. OBJECTIVE To describe a minimally invasive transcorporeal approach for cervical intradural extramedullary tumor resection and spinal cord decompression. Previous literature regarding available treatment options was reviewed. METHODS A patient with known intracranial malignant melanoma presented with severe myelopathy from metastatic melanoma compressing the cervical cord. The anterior transcorporeal approach for total tumor resection and spinal cord decompression under a microscope was planned. Under spinal navigation, small bone tunneling was performed to expose and remove the tumor without compromising cervical stability. RESULTS The melanoma resection was successfully performed without complications. Myelopathic symptoms were significantly improved with the absence of instability or local recurrence at the long-term follow-up. CONCLUSION We present the anterior transcorporeal approach that can be used to resect the tumor in the ventral cervical region and effectively decompress the cervical cord without complications. Moreover, this approach is the minimally invasive surgical technique that preserves spinal stability, minimizes bleeding, and shortens the hospital stay.
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Affiliation(s)
- Khanathip Jitpakdee
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Si Racha, Thailand
| | - Vit Kotheeranurak
- Department of Orthopedics, Queen Savang Vadhana Memorial Hospital, Si Racha, Thailand
| | - Woo Jung Lim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Jin-Sung Kim
- Spine Center, Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
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杨 俊, 楚 磊, 邓 忠, Kai-Xuan L, 邓 锐, 陈 浩, 刘 鹏, 刘 团, 荣 雪, 郝 定. [Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2020; 34:543-549. [PMID: 32410418 PMCID: PMC8171849 DOI: 10.7507/1002-1892.201905118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 02/27/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach. METHODS According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C 3, 4 in 2 cases, C 4, 5 in 8 cases, C 5, 6 in 9 cases, and C 6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated. RESULTS Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation ( P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one ( t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation ( t=0.881, P=0.421). CONCLUSION Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.
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Affiliation(s)
- 俊松 杨
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 磊 楚
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 忠良 邓
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - Liu Kai-Xuan
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 锐 邓
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 浩 陈
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 鹏 刘
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 团江 刘
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 雪芹 荣
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
| | - 定均 郝
- 西安交通大学附属红会医院脊柱外科(西安 710054)Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China
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Apostolakis S. Transcorporeal Tunnel Approach for Cervical Radiculopathy and Myelopathy: A Systematic Review and Meta-Analysis. World Neurosurg 2020; 138:318-327. [PMID: 32217171 DOI: 10.1016/j.wneu.2020.03.082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/12/2020] [Accepted: 03/13/2020] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The transcorporeal tunnel approach is a relatively new alternative of anterior cervical decompression and fusion for the treatment of cervical radiculopathy and myelopathy, with its main presumed advantage being the preservation of the intervertebral space. The aim of the present article is to present the outcomes of the systematic review and meta-analysis regarding the short-term outcomes of this surgical technique. METHODS A systematic review and a meta-analysis using the random-effects method of the available studies were performed to assess the safety and efficiency of the transcorporeal tunnel approach for cervical radiculopathy and myelopathy. RESULTS In total, 15 eligible studies were identified, with a cumulative number of 254 patients. Pooled data yielded a complication rate of 0.053 and a failure rate of the technique of 0.081; a patient-reported favorable outcome of 0.94 was documented. The available data did not allow for a definite conclusion on the effects of the technique on the intervertebral space height. CONCLUSIONS Although technically challenging, like all minimally invasive methods, the transcorporeal tunnel approach seems to be a safe and efficient option for the treatment of cervical radiculopathy and myelopathy, presenting comparable outcome profiles to alternative open or less invasive techniques.
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Kong W, Xin Z, Du Q, Cao G, Liao W. Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord for single-segment cervical spondylotic myelopathy: The technical interpretation and 2 years of clinical follow-up. J Orthop Surg Res 2019; 14:461. [PMID: 31870395 PMCID: PMC6929378 DOI: 10.1186/s13018-019-1474-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Accepted: 11/14/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND ACDF is the standard procedure for treatment of cervical spondylotic myelopathy (CSM), but a long-term follow-up has been revealed some associated complications of swallowing discomfort, displacement of the fusion device, and accelerated degeneration of the adjacent segment. OBJECTIVE To evaluate the clinical outcomes of anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord (APFETDSC) for single-segment CSM and to analyze the clinical efficacy, surgical characteristics, and complication prevention. METHODS A total of 32 patients who underwent APFETDSC for single-segment CSM from Aug. 2015 to Apr. 2017 were reviewed. Operating time, time of walking out of bed postoperation, length of hospitalization, complications, neck pain visual analog scale (VAS), and Japanese Orthopaedic Association Score (JOA) were evaluated. Measurement of intervertebral height (HI) of surgical segments on cervical neutral X-ray, Harrison's method was used to measure cervical spine angle (CSA). RESULTS The operation time was 103.3 ± 12.95 min, time of walking out of bed after surgery was 19.81 ± 4.603 h, the length of postoperative hospital stay was 57.48 ± 19.48 h. The postoperative neck pain VAS and JOA were significantly improved compared with preoperation(p < 0.001). The postoperative HI was statistical significance decreased compared with preoperation(p < 0.001), but the HI reduction was less than 0.5 mm, without adverse clinical symptoms. The postoperative CSA was significantly improved compared with preoperative(p < 0.001). The excellent and good rate was 87.5%, and the JOA improvement rate was 75.52 ± 11.11%. There was no cervical instability, vertebral fracture, wound infection, and other complications. CONCLUSIONS APFETDSC is a safe and effective minimally invasive technique with small auxiliary injuries for single-segment CSM while avoiding the sequelae of ACDF. Its short-term clinical efficacy was good and no significant effect on cervical stability.
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Affiliation(s)
- Weijun Kong
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Zhijun Xin
- Department of Spine Surgery, The First Affiliated Hospital of Zunyi Medical University, Zunyi, 563000 Guizhou China
| | - Qian Du
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Guangru Cao
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
| | - Wenbo Liao
- Department of Orthopaedic, The Second Affiliated Hospital of Zunyi Medical University, 1 Xinpu Rd, Zunyi, 563000 Guizhou China
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Percutaneous Full-Endoscopic Anterior Transcorporeal Diskectomy for Massive Migrated Cervical Disk Herniation Treatment: Case Report and Review of the Literature. World Neurosurg 2019; 132:47-52. [PMID: 31442650 DOI: 10.1016/j.wneu.2019.08.054] [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: 05/17/2019] [Revised: 08/08/2019] [Accepted: 08/09/2019] [Indexed: 11/22/2022]
Abstract
BACKGROUND With the continuous advancement of the spinal endoscopic technique in recent years, full-endoscopic operations provide a new approach for the treatment of migrated cervical disk herniation. CASE DESCRIPTION A 42-year-old man presented with nuchal pain and limb numbness for 2 months, with recently developed symptoms of unstable walking. Physical examination revealed a diminished skin sensitivity to pain and temperature, beginning at the C4 dermatome. The muscle strength of both upper limbs decreased to grade 4, and the muscle strength was grade 4 on both sides of the lower limbs. Hoffmann sign and ankle clonus were positive. Magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated that a large piece of a segmental disk had migrated to the rear area of the C4 vertebral body and seriously compressed the spinal cord. A percutaneous full-endoscopic anterior transcorporeal cervical diskectomy was performed on the patient. CONCLUSIONS The postoperative Japanese Orthopaedic Association (JOA) score increased from 8 to 11 points. At 2-year follow-up, the JOA score was 16 points, the improvement rate was 88.9%, and cervical vertebrae MRI, cervical CT scan, and 3-dimensional reconstruction showed that the cervical vertebrae channel healed without vertebral fractures, bony channel collapse, adjacent segment degeneration, or intervertebral space height.
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Okazaki T, Nakagawa H, Mure H, Yagi K, Hayase H, Takagi Y, Saito K. Microdiscectomy and Foraminotomy in Cervical Spondylotic Myelopathy and Radiculopathy. Neurol Med Chir (Tokyo) 2018; 58:468-476. [PMID: 30298831 PMCID: PMC6236210 DOI: 10.2176/nmc.oa.2018-0077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study was to assess the efficacy of microdiscectomy, cage fixation, and right tranuncal foramintomy for the patients suffering from right radiulo-myelopathy. Anterior cervical foraminotomy was reported to be an effective option for the treatment of cervical degenerative radiculopathy but with the problem of recurrence. Since Hakuba reported the method of trans-unco-discal approach in 1976, it was designed as keyhole foraminotomy which was called transuncal approach, transpedicular approach or transvertebral approach. In the anterior approach, we usually use the right-sided approach because most of us are right-handed surgeons. We retrospectively investigated our patients who had the right foraminal stenosis causing radiculopathy and were treated with microdiscectomy, cage fixation, and right keyhole transuncal foraminotomy. Since 2011, 23 patients were treated with the manner. All of the 23 patients who had central canal stenosis and among the 23 patients, 8 patients showed only right radiculopathy and 15 patients showed radiculo-myelopathy. In all patients, the radiculopathy disappeared or significantly improved without any complications postoperatively. The average of VAS scores was 7.6 ± 2.2 in preoperative state, 2.8 ± 2.2 at discharge, and 1.1 ± 1.6 in 1 month after surgery. The average of follow-up time was 38.3 months and they had no recurrence of radiculopathy. We showed that this manner is effective and one option for the combined disease of right foraminal and canal stenosis and we believe that this manner is not complex and safe if we can understand the anatomy.
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Affiliation(s)
- Toshiyuki Okazaki
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital.,Department of Neurosurgery, Tokushima University
| | | | - Hideo Mure
- Department of Neurosurgery, Tokushima University
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School
| | - Hitoshi Hayase
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | | | - Koji Saito
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
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Jia ZQ, Zhao LT, Rong XQ, Lv HW, He XJ. Letter to the Editor Regarding "Percutaneous Full-Endoscopic Anterior Transcorporeal Procedure for Cervical Disc Herniation: A Novel Procedure and Early Follow-Up Study". World Neurosurg 2018; 118:385. [PMID: 30248813 DOI: 10.1016/j.wneu.2018.05.157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Accepted: 05/22/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Zhi-Qiang Jia
- Department of Spinal Surgery, The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang, People's Republic of China; Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xian, People's Republic of China; Pain and spine minimally invasive centers, The Third People's Hospital of Hainan Province, Sanya, People's Republic of China
| | - Li-Tao Zhao
- Department of Spinal Surgery, The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang, People's Republic of China; Pain and spine minimally invasive centers, The Third People's Hospital of Hainan Province, Sanya, People's Republic of China
| | - Xue-Qin Rong
- Pain and spine minimally invasive centers, The Third People's Hospital of Hainan Province, Sanya, People's Republic of China
| | - Hai-Wen Lv
- Department of Spinal Surgery, The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang, People's Republic of China
| | - Xi-Jing He
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, Xian, People's Republic of China.
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Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the C4-C5 levels: a technical note. Spine J 2016; 16:659-66. [PMID: 26850173 DOI: 10.1016/j.spinee.2016.01.187] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 12/01/2015] [Accepted: 01/14/2016] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT With the continuous development of the spinal endoscopic technique in recent years, percutaneous endoscopic cervical discectomy (PECD) has emerged, which bridges the gap between conservative therapy and traditional surgery and has been mainly divided into the anterior transdiscal approach and the posterior interlaminar access. Because of the relatively greater violation to the anterior nucleus pulposus, there is a higher potential of postoperative intervertebral space decrease in the anterior transdiscal approach than in the posterior interlaminar access. In addition, when the herniated lesion is migrated upward or downward behind the vertebral body, both approaches, and even anterior cervical discectomy and fusion, are impractical, and corpectomy is commonly considered as the only efficacious treatment. Anterior transcorporeal approach under endoscopy could enable an individual and adjustable trajectory within the vertebral body under different conditions of disc herniation preserving the motion of adjacent segment, especially in a migrated or sequestered lesion. PURPOSE This report aimed to first describe a novel anterior transcorporeal approach under endoscopy in which we addressed a migrated disc herniation at the C4-C5 levels. STUDY DESIGN A technical report was carried out. PATIENT SAMPLE A 37-year-old woman presented with posterior neck pain and weakness of extremities for 9 months. On neurologic examination, tingling sensation and numbness were not obvious. However, the power of extremities was dramatically decreased at a level of 3. Hoffmann sign was positive in the bilateral hand. Magnetic resonance imaging (MRI) showed a huge herniation of the C4-C5 disc compressing the median area of the spinal cord. Besides the C4-C5 disc herniation, preoperative computer tomography (CT) also detected that the herniated disc had partial calcification. A novel anterior transcorporeal approach of PECD, through the vertebral body of C5, was performed to address a migrated disc herniation at the C4-C5 levels. OUTCOME MEASURES The posterior neck pain was measured using the visual analog scale (VAS). METHODS A novel anterior transcorporeal approach under endoscopy was performed to address a migrated disc herniation at the C4-C5 levels. RESULTS This operation was accomplished in 75 minutes. Postoperatively, the drainage tube was retained into the drilling hole for 24 hours to avoid the possibility of hematoma. The patient was advised to wear a neck collar for 3 weeks. Immediately after the operation, the posterior neck pain improved from VAS 7/10 preoperatively to 3/10, and the myodynamia of extremities improved stepwise. At 12 hours postoperatively, the range of motion was also improved. In the further follow-up, the patient has completely recovered from the preoperative symptoms, whose myodynamia of extremities is normal. Besides the postoperative MRI, a total removal of the herniated disc and the transcorporeal drilling tunnel are observed in CT. At postoperative 3-month follow-up, neither disc space narrowing nor instability was observed on CT, in which the bone defect after drilling tunnelwas partially decreased, indicating bone healing. There were no surgery-related complications, such as dysphagia, Horner syndrome, recurrent laryngeal nerve palsy, vagus nerve injury, tracheoesophageal injury, or cervical hematocele. CONCLUSIONS As a supplement to the described surgical approach of PECD, the transcorporeal approach is a novel access for the treatment of cervical intervertebral disc herniation. Among the advantages of this approach are providing a clear visual field during microendoscopic surgery and decreasing the intraoperative iatrogenic injury to, as well as avoiding violation to the discal tissue. Theoretically, the potential of secondary decline of intervertebral height is low. However, as the limitation of one case shows, whether this transcorporeal approach is efficacious and reliable should be verified in a further comparative cohort study with a large volume of patients.
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Park HW, Park KS, Park MS, Kim SM, Chung SY, Lee DS. The Comparisons of Surgical Outcomes and Clinical Characteristics between the Far Lateral Lumbar Disc Herniations and the Paramedian Lumbar Disc Herniations. KOREAN JOURNAL OF SPINE 2013; 10:155-9. [PMID: 24757478 PMCID: PMC3941755 DOI: 10.14245/kjs.2013.10.3.155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2013] [Revised: 08/26/2013] [Accepted: 08/28/2013] [Indexed: 11/19/2022]
Abstract
Objective The purpose of this study is to analyze clinical characteristics and surgical outcomes of the far lateral and the paramedian disc herniations. Methods The 88 patients who underwent an operation for lumbar disc herniations were reviewed. Visual analogue scale of leg and back pain, occurrence of sensory dysesthesia and motor deficit before and after operations were used to compare the far lateral with the paramedian disc herniations. Results Statistically, the far lateral herniations had more severe radicular leg pain and showed more frequent occurrence of sensory dysesthesia than paramedian herniations before operation (p<0.05). In the far lateral herniation group, preoperatively, 15 patients (75%) had sensory dysesthesia and among them, 4 patients (27%) showed improvement. In the paramedian herniation group, preoperatively, 25 patients (37%) had sensory dysesthesia and among them, 21 patients (84%) showed improvement. The degree of improvement in sensory dysesthesia was statistically higher in paramedian herniation group (p<0.05). In the far lateral herniation group, preoperatively, 11 patients (55%) had motor deficit and among them, 10 patients (91%) showed improvement. In the paramedian herniations, preoperatively, 29 patients (43%) had motor deficit and among them, 25 patients (86%) showed improvement. The degree of improvement in motor deficit was not statistically significant between groups (p>0.05). Conclusion Preoperatively, the far lateral herniations had more severe radicular leg pain and frequent occurrence of sensory dysesthesia. Postoperatively, the sensory dysesthesia was less improved and back pain was more severe in the far lateral herniations.
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Affiliation(s)
- Hyun Wook Park
- Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Taejon, Korea
| | - Ki Seok Park
- Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Taejon, Korea
| | - Moon Sun Park
- Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Taejon, Korea
| | - Seong Min Kim
- Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Taejon, Korea
| | - Seung Young Chung
- Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Taejon, Korea
| | - Do Sung Lee
- Department of Neurosurgery, Eulji University Hospital, College of Medicine, Eulji University, Taejon, Korea
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Han JS, Lee SH, Kim ES, Eoh W. Regrowing synovial chondromatosis in a cervical facet joint with radiculopathy. KOREAN JOURNAL OF SPINE 2012; 9:253-6. [PMID: 25983825 PMCID: PMC4431012 DOI: 10.14245/kjs.2012.9.3.253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 09/04/2012] [Accepted: 09/26/2012] [Indexed: 12/02/2022]
Abstract
Synovial chondromatosis (SC) in the spine is rare. There are few reports of associated cervical radiculopathy and there has not been a case reported of regrowing cervical SC. Here we report a 21-year-old man with a SC of a cervical facet joint that extended into the intervertebral foramen and compressed the cervical nerve root. The same symptom developed three years following the first operation. Computed tomography (CT) scans and Magnetic resonance imaging (MRI) showed multiple calcified nodules anterior to the right facet joint of C6-7 that extended into the intervertebral foramen. A mass removal was performed just as in the previous operation with a subtotal facetectomy. When vertebral SC is suspected, complete removal involving the bone and synovium should be considered as the standard treatment option.
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Affiliation(s)
- Jae-Suk Han
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seung Hoon Lee
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun-Sang Kim
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Whan Eoh
- Department of Neurosurgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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