Percutaneous Full-Endoscopic Anterior Transcorporeal Procedure for Cervical Disc Herniation: A Novel Procedure and Early Follow-Up Study

Object. The authors sought to evaluate retrospectively the radiological and clinical outcome of anterior cervical discectomy followed by implantation of an empty carbon fiber composite frame cage (CFCF) in the treatment of patients with cervical disc herniation and monoradiculopathy. Methods. Twenty-five consecutive patients (12 men, 13 women, mean age 45 years) with monoradiculopathy due to cervical disc herniation were treated by anterior cervical discectomy followed by implantation of an empty CFCF cage. On lateral flexion—extension radiographs segmental stability at a mean follow up of 14 months (range 5–31 months) was demonstrated in all 25 patients, and bone fusion was documented in 24 of 25 patients. The mean anterior intervertebral body height was 3.4 mm preoperatively and 3.8 mm at follow up in 20 patients. In these patients the mean segmental angle (angle between lower endplate of lower and upper vertebra) was 0.9° preoperatively and 3.1° at follow up. In the remaining five patients preoperative images were not retrievable. Self-scored neck pain based on a visual analog scale (1, minimum; 10, maximum) changed from a preoperative average of 5.6 to an average of 2 at follow up; radicular pain was reduced from 7.7 to 2.1 postoperatively. Analysis of the SF12 questionnaires showed a significant improvement in both the physical capacity score (preoperative mean 32.4 points; follow up 46 points) and the mental capacity score (preoperative mean 45.8 points; follow up 57.5 points). Conclusions. Implantation of an empty CFCF cage in the treatment of cervical disc herniation and monoradiculopathy avoids donor site morbidity associated with autologous bone grafting as well as the use of any supplementary material inside the cage. Restoration or maintenance of intervertebral height and thus segmental lordosis and a very high rate of segmental stability and fusion are achieved using this technique.

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Spontaneous Healing of Brown-Sequard Syndrome Caused by Cervical Disc Herniation

10.29007/4srb ◽

2019 ◽

Author(s):

Xiaoyun Liu ◽

Hongzhi Hu ◽

Zhengwu Shao ◽

Mao Xie

Keyword(s):

Surgical Treatment ◽

Disc Herniation ◽

Rare Case ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Complete Disappearance ◽

Spontaneous Healing ◽

Spinal Neoplasm ◽

Brown Sequard Syndrome

Brown-Sequard syndrome (BSS) is most commonly seen in patients with spinal trauma and extramedullary spinal neoplasm. Pure BSS caused by cervical disc herniation is extremely rare. Operative treatment is generally recommended those patients with BSS to improve neurological function. Here, we report a rare case of spontaneous healing of BSS caused by cervical disc herniation. Two years follow-up showed complete disappearance of symptoms without recurrence. To our knowledge, no similar cases have been reported before. Therefore, for appropriate patients, conservative treatment can be considered for a few months before deciding on surgical treatment.

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Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

January 2018 - Pain Physician ◽

10.36076/ppj.2021.24.e811 ◽

2021 ◽

Vol 24 (6) ◽

pp. E811-E819

Keyword(s):

Clinical Efficacy ◽

Study Design ◽

Disc Herniation ◽

Small Sample ◽

Cervical Disc Herniation ◽

Cervical Disc ◽

Disc Protrusion ◽

Average Hospital ◽

Cervical Discectomy

BACKGROUND: Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited. OBJECTIVES: To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application. STUDY DESIGN: A retrospective cohort study. SETTING: A center for spine surgery, rehabilitation department and pain medicine. METHODS: Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations. RESULTS: The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body. LIMITATIONS: This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design. CONCLUSIONS: Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results. Trial registration: The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820). KEY WORDS: Percutaneous full-endoscope, anterior transcorporeal approach, cervical discectomy, cervical disc herniation, minimally invasive surgery

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