Anterior Endoscopic Cervical Discectomy and Foraminoplasty for Herniated Disc and Lateral Canal Stenosis

Characteristics of endoscopic lumbar discectomy system (ELDS) developed in Japan were introduced, and the first 50 cases were clinically evaluated. Patients included: 4 cases of double disc herniationat two levels; 1 cranially and 3 caudally migrated discs; 3 spinal canal stenosis; 1 synovial cyst; and 3 persistent ring apophysis. In 4 central disc herniation cases, 1 case was approached bilaterally and other 3 cases unilaterally. Using a step-dilator system, targeting inter-laminar space was exposed and a tubular retractor either of 16 or 18 mm diameter was inserted through the paravertebral muscle. A 30° endoscope of 3 mm diameter was installed to a tubular retractor. Partial laminectomy and resection of ligamentum flavum were performed using microsurgical instruments, followed by medial retraction of the symptomatic nerve root and incision of the herniated disc. Average surgery time was 119 minutes and estimated blood loss was 49.1 gm. Patients left their bed at 1.9 days post-operative and average hospital-stay was 11.5 days. Recovery ratio of the Japanese Orthopedic Association (JOA) score was 80.7%. Average visual analog pain scale at the first day post-operative was 2.9 cm and CRP at the 7th day was 0.4 mg/dl. Adjacent two-level discectomy was possible with one midline skin incision. Coexistence of severe lumbar spinal canal stenosis was most technically demanding pathology. ELDS provided brightened and magnified surgery field. This can be an effective assistant for minimally invasive lumbar disc surgery.

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Expression of matrix metalloproteinases 2 and 9 and TGF-b in ligamentum flavum hypertrophy

Coluna/Columna ◽

10.1590/s1808-18512014130300451 ◽

2014 ◽

Vol 13 (3) ◽

pp. 206-209

Author(s):

Marcelo Ferraz de Campos ◽

Cintia Pereira de Oliveira ◽

Maria Aparecida da Silva Pinhal ◽

Luciano Miller Reis Rodrigues

Keyword(s):

Matrix Metalloproteinases ◽

Spinal Stenosis ◽

Ligamentum Flavum ◽

Statistical Significance ◽

Herniated Disc ◽

Older Individuals ◽

Younger Patients ◽

Canal Stenosis ◽

Significant Difference ◽

Hematoxylin Eosin

OBJECTIVE: To evaluate the expression of matrix metalloproteinases and TGFb in patients with spinal stenosis and in younger patients who have herniated disc. METHODS: 19 samples of LA were analyzed, nine of them with lumbar canal stenosis and 10 with disc herniation. Of the total, five patients were aged between 15 and 40 years, 10 were between 40 and 65 years and four had more than 65 years. Representative areas of LF were chosen based on the staining of tissues with hematoxylin-eosin. The 3µm-thick sections embedded in paraffin and fixed in formalin were deparaffinized and rehydrated. All ligaments were incubated overnight at 4 °C with primary antibodies. RESULTS: An increase of TGFb was verified in older individuals, although without statistical significance. CONCLUSION: Metalloproteinases showed no significant difference between both groups with respect to age and type of abnormality of the spine.

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Anterior cervical discectomy with and without fusion

Journal of Neurosurgery ◽

10.3171/jns.1983.59.2.0252 ◽

1983 ◽

Vol 59 (2) ◽

pp. 252-255 ◽

Cited By ~ 91

Author(s):

Jarl Rosenørn ◽

Elisabeth Bech Hansen ◽

Mary-Ann Rosenørn

Keyword(s):

Clinical Outcome ◽

Randomized Study ◽

Anterior Cervical Discectomy ◽

Prospective Randomized Study ◽

Herniated Disc ◽

Content Type ◽

Cervical Discectomy ◽

Fine Print

✓ A prospective randomized study to compare discectomy without (DE) and with fusion (DEF) included 63 patients operated on for cervical herniated disc. The clinical outcome 3 and 12 months postoperatively was significantly better after DE than after DEF (p < 0.05). Significantly more patients operated on with DE returned to work during the first 9 weeks postoperatively than patients operated on with DEF (p < 0.005 to 0.05). The prognosis is significantly better for men than for women after DEF (p < 0.005), while no difference can be shown after DE.

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Computed Tomographic, Myelographic, and Operative Findings in Patients with Suspected Herniated Lumbar Discs

Neurosurgery ◽

10.1227/00006123-198302000-00009 ◽

1983 ◽

Vol 12 (2) ◽

pp. 184-188 ◽

Cited By ~ 5

Author(s):

Nazih A. Moufarrij ◽

Russell W. Hardy ◽

Meredith A. Weinstein

Keyword(s):

Computed Tomography ◽

Intervertebral Disc ◽

Clinical Diagnosis ◽

Herniated Disc ◽

Lumbar Intervertebral Disc ◽

Disc Protrusion ◽

Ct Myelography ◽

Computed Tomographic ◽

Canal Stenosis ◽

Operative Findings

Abstract Fifty patients presenting with a suspected herniated lumbar intervertebral disc were evaluated with sector computed tomography (CT). Excluded from this series were patients with prior lumbar laminectomy or a clinical diagnosis of lumbar canal stenosis. Forty-six of the patients also underwent preoperative lumbar myelography. All patients subsequently underwent laminectomy. In 40 patients (80%), CT was positive. In the remaining 10 patients (20%), it was negative; in this group the myelogram correctly predicted the lesion in 8 (80%), Sector CT correctly predicted the nature of the lesion in 24 patients (48%), was incorrect in 14 (28%), and gave incomplete findings in 12 (24%). CT was most accurate when it demonstrated a disc protrusion as the only finding. In this group, sector CT correctly predicted the operative findings in 24 of 25 patients (96%). CT was less accurate when spondylitic compression was diagnosed. This study suggests that sector CT is a useful test in the evaluation of patients with sciatica and that, when a soft herniated disc is demonstrated on CT, myelography may be omitted.

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Single level anterior cervical discectomy and fusion in multilevel herniated disc, a case report

Annals of Medicine and Surgery ◽

10.1016/j.amsu.2020.11.064 ◽

2020 ◽

Vol 60 ◽

pp. 708-713

Author(s):

S. Dohar Tobing ◽

Petrus Aprianto

Keyword(s):

Case Report ◽

Anterior Cervical Discectomy ◽

Herniated Disc ◽

Cervical Discectomy ◽

Single Level

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Minimally Invasive Posterior Cervical Discectomy: 2-Dimensional Operative Video

Operative Neurosurgery ◽

10.1093/ons/opab311 ◽

2021 ◽

Author(s):

Seokchun Lim ◽

Thomas Marcus Zervos ◽

Travis Hamilton ◽

Victor Chang

Keyword(s):

Minimally Invasive ◽

Healthcare Cost ◽

Cost Savings ◽

Herniated Disc ◽

Ambulatory Setting ◽

Invasive Technique ◽

Foraminal Stenosis ◽

Illustrative Case ◽

Cervical Discectomy ◽

Splitting Technique

Abstract Minimally invasive posterior cervical microdiscectomy is an appropriate surgical approach for patients with foraminal stenosis from herniated disc with radicular symptoms that is not responsive to conservative management. While anterior cervical discectomy and fusion (ACDF) or arthroplasty is increasingly utilized to treat herniated disc, a posterior approach eliminates the risk of potential approach related injuries to the esophagus, carotid artery, or recurrent laryngeal nerve. Additional benefits of posterior decompression include avoidance of instrumentation, which represents an increased healthcare cost, as well as potential long-term risks of adjacent-level pathologies or device failures. A traditional open posterior cervical approach has the potential to cause significant postoperative pain due to dissection of the paraspinal musculature and the potential for disrupting the posterior tension band with inadvertent injury to the interspinous ligaments. Such disadvantages are reduced by utilizing the minimally invasive technique where a small tubular working channel is placed through a muscle splitting technique via a paramedian approach. This technique minimizes the need for muscle stripping, and thus decreases postoperative functional and structural disturbance. Discectomy in this case can also be safely performed with minimal retraction at the axilla of the nerve root. Additionally, this approach can be utilized in an ambulatory setting, which coupled with the lack of any additional instrumentation helps contribute to the overall healthcare cost savings of such a procedure. This video describes how the minimally invasive posterior cervical discectomy can be effectively and safely performed in this illustrative case. The patient consented to the procedure and publication.

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Rotational vertebral artery occlusion secondary to adjacent-level degeneration following anterior cervical discectomy and fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.3.spine13452 ◽

2014 ◽

Vol 20 (6) ◽

pp. 714-721 ◽

Cited By ~ 11

Author(s):

Colin C. Buchanan ◽

Nancy McLaughlin ◽

Daniel C. Lu ◽

Neil A. Martin

Keyword(s):

Vertebral Artery ◽

Head Rotation ◽

Artery Occlusion ◽

Adjacent Segment Degeneration ◽

Anterior Cervical Discectomy ◽

Herniated Disc ◽

Adjacent Segment ◽

Vertebrobasilar Insufficiency ◽

Cervical Discectomy ◽

Vertebral Artery Occlusion

Rotational vertebral artery occlusion (RVAO), or bow hunter's syndrome, most often occurs at the C1–2 level on physiological head rotation. It presents with symptoms of vertebrobasilar insufficiency (VBI). Several previously published studies have reported on subaxial sites of vertebral artery (VA) compression by head rotation. The authors report a case of subaxial spine RVAO due to adjacent-segment degeneration. A 52-year-old man presented with dizziness when rotating his head to the left. Twenty years earlier, he had undergone a C4–5 anterior cervical discectomy and fusion (ACDF) for a herniated disc. Imaging studies including a dynamic CT angiography and dynamic catheter angiography revealed occlusion of the left VA at the C3–4 level when the patient turned his head to the left, in the setting of an aberrant vertebrobasilar system. Successful treatment was achieved by surgical decompression of the left VA and C3–4 ACDF. Expedited diagnosis and treatment are dependent on the recognition of this unusual manifestation of RVAO, especially when patients present with nonspecific symptoms of VBI.

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Cervical disc herniation manifesting as a Brown-Sequard syndrome

Journal of Neurosciences in Rural Practice ◽

10.4103/0976-3147.98229 ◽

2012 ◽

Vol 03 (02) ◽

pp. 182-183 ◽

Cited By ~ 2

Author(s):

Kunio Yokoyama ◽

Masahiro Kawanishi ◽

Makoto Yamada ◽

Toshihiko Kuroiwa

Keyword(s):

Spinal Cord ◽

Disc Herniation ◽

The Body ◽

Sensory Function ◽

Herniated Disc ◽

Cervical Disc ◽

Spinal Neoplasm ◽

Canal Stenosis ◽

Body Magnetic Resonance Imaging ◽

Brown Sequard Syndrome

ABSTRACTBrown-Sequard syndrome is commonly seen in the setting of spinal trauma or an extramedullary spinal neoplasm. The clinical picture reflects hemisection of the spinal cord. We report a rare case of Brown-Sequard syndrome caused by a large cervical herniated disc. A 63-year-old man presented with progressive right hemiparesis and disruption of pain and temperature sensation on the left side of the body. Magnetic resonance imaging showed large C3-C4 disc herniation compressing the spinal cord at that level, with severe canal stenosis from C4 through C7. Decompressive cervical laminoplasty was performed. After surgery, complete sensory function was restored and a marked improvement in motor power was obtained.

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