scholarly journals Endoscopic foraminotomy using a microendoscopic discectomy system in cadaveric specimens

1998 ◽  
Vol 4 (2) ◽  
pp. E4 ◽  
Author(s):  
Sung Woo Roh ◽  
Daniel H. Kim ◽  
Alberto C. Cardoso ◽  
Richard G. Fessler
Keyword(s):  
Disc Herniation ◽  
Facet Joint ◽  
Contralateral Side ◽  
Cervical Disc ◽  
Foraminal Stenosis ◽  
Transverse Diameter ◽  
Disc Disease ◽  
Cadaveric Specimen ◽  
Open Procedure ◽  
Microendoscopic Discectomy

Although the anterior approach is more commonly performed for the treatment of cervical disc disease, the posterior approach has distinct advantages in selected cases of foraminal stenosis and posterolateral disc herniation. The authors performed cervical key hole foraminotomies using a microendoscopic discectomy (MED) system in four cadaveric cervical spine specimens to evaluate this minimally invasive surgical approach for cervical disc diseases. The amount of bone decompression achieved by using the MED system was compared with that achieved by using the open foraminotomy procedure in each cadaveric specimen. Three noncontiguous cervical nerve roots were selected between C-3 and C-8 in each specimen and were decompressed using the MED system on one side and using the open foraminotomy procedure on the contralateral side. Postoperative computerized tomography (CT) myelography showed that adequate bone decompression was achieved by using either the MED or open procedure in all specimens. Postoperatively, open dissection was performed to confirm and compare the amount of decompression in both the MED and open procedures. The laminotomy size (vertical and transverse diameter), the length of decompressed nerve root, and the proportion of removed facet joint were measured on every operative level. The average vertical diameter of laminotomy area and the percentage of facet removed were significantly greater in the MED procedure than the open procedure (p < 0.05). The transverse diameter of the laminotomy area and the average decompressed root length were not significantly different between MED and open surgery. The authors conclude that endoscopic cervical foraminotomy using the MED system is a feasible procedure and may be clinically applicable in the treatment of foraminal stenosis and laterally located cervical disc herniation.

Use of a polymethylmethacrylate cervical cage in the treatment of single-level cervical disc disease

2005 ◽  
Vol 3 (1) ◽  
pp. 24-28 ◽  
Author(s):  
Jyi-Feng Chen ◽  
Chieh-Tsai Wu ◽  
Sai-Cheung Lee ◽  
Shih-Tseng Lee
Keyword(s):  
Cancellous Bone ◽  
Disc Herniation ◽  
Interbody Fusion ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Cervical Disc Disease ◽  
Disc Disease ◽  
Content Type ◽  
Single Level ◽  
Fine Print

Object. Polymethylmethacrylate (PMMA) bone cement has been used as a spacer in the treatment of patients with cervical disc disease with good long-term outcomes, but solid bone fusion has not been demonstrated in all cases. To achieve cervical interbody fusion, the authors designed a modified PMMA cervical cage that they filled with spongy bone for the treatment of single-level cervical disc herniation. Methods. Sixty-three patients underwent anterior cervical microdiscectomy and implantation of a PMMA cervical cage filled with autograft cancellous bone and were followed for a minimum of 2 years. The fusion rates were 90.5 and 100% at the 6- and 12-month follow-up examinations, respectively. The mean intervertebral disc height gain was 3.4 ± 1.9 mm when preoperative and 24-month postoperative values were compared. Neck pain, measured using the Huskissan visual analog scale (0 mm, no pain; 100 mm, worst possible pain), decreased from 71 ± 13 mm at preoperative baseline to 28 ± 17 at 6, 23 ± 19 at 12, and 31 ± 19 mm at 24 months. Based on the same scale, radicular pain decreased from 83 ± 15 mm at preoperative baseline to 24 ± 11 at 6, 27 ± 13 at 12, and 22 ± 11 mm at 24 months. The self-rated clinical outcome was excellent in 45 (71.4%) and good in 18 (28.6%) of the 63 patients. Conclusions. The autograft cancellous bone—filled PMMA cage is safe and effective for cervical interbody fusion in the treatment of single-level cervical disc herniation and monoradiculopathy.

Anterior surgery for cervical disc disease

1980 ◽  
Vol 53 (1) ◽  
pp. 1-11 ◽  
Author(s):  
L. Dade Lunsford ◽  
David J. Bissonette ◽  
Peter J. Jannetta ◽  
Peter E. Sheptak ◽  
David S. Zorub
Keyword(s):  
Disc Herniation ◽  
University Hospital ◽  
Cervical Disc ◽  
Complete Relief ◽  
Anterior Fusion ◽  
Disc Disease ◽  
Anterior Surgery ◽  
Cervical Surgery ◽  
Anterior Cervical Surgery ◽  
Results Of Surgery

✓ Between 1971 and 1977, 334 patients at the Presbyterian-University Hospital underwent anterior surgery for treatment of hard or soft cervical disc herniation. Of these patients, 295 had radicular symptoms only. This retrospective study details the results of anterior cervical surgery for treatment of lateral disc herniation in 253 patients who survived 1 to 7 years postoperatively. Sixty-seven percent had excellent or good results. Although 77% initially noted complete relief of symptoms after surgery, 38% subsequently developed one or more recurrent symptoms at some time during the follow-up period. The overall results of surgery for soft disc cases were no different from the results for hard discs, although significantly more hard disc cases required postoperative conservative treatment. The results of surgery after anterior fusion were no different than the results after anterior discectomy alone. However, overall postoperative complications were more frequent and hospitalizations were longer in the patients who underwent fusion. Patients with multiple-level surgery had statistically similar results to those with single-level surgery. None of the nine preoperative clinical features reported by others to influence the results of anterior cervical surgery were found to consistently affect outcome in the present series.

scholarly journals Are Foraminal Stenosis Severity and Herniation Level Associated with the Treatment Success of Cervical Interlaminar Epidural Steroid Injection?

2020 ◽  
Vol 3;23 (6;3) ◽  
pp. 325-332
Author(s):  
Ipek Saadet Edipoglu
Keyword(s):  
Disc Herniation ◽  
Treatment Success ◽  
Radicular Pain ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Foraminal Stenosis ◽  
Spinal Level ◽  
Steroid Injections ◽  
Epidural Steroid Injections ◽  
Epidural Steroid

Background: Foraminal stenosis, defined as a narrowing of the cervical neural foramen, is one of the most common causes of upper extremity radicular pain. Objectives: The aim of our study was to determine the effects of the severity of neural foraminal stenosis and spinal herniation level on treatment success in patients treated with interlaminar epidural steroid injections (ILESI) due to cervical disc herniation-related radiculopathy and their possible predictive roles. Study Design: A retrospective assessment. Setting: A university hospital interventional pain management center. Methods: We performed our study between August 2017 and February 2019, retrospectively. All patients’ demographic characteristics, clinical and demographic data, including pain scores before and after cervical ILESI in the first hour, third week, and third month follow-ups, presence of motor deficits, symptom side, symptom duration before cervical ILESI, and whether there was progression to surgery in the 3-month period after injection, were collected. Results: We evaluated 61 patients in the final analysis. When the spinal herniation levels and foraminal stenosis grades were compared, there was a significant difference between the groups (P = 0.003, P = 0.005). We reported significant correlations between foraminal stenosis grade (odds ratio [OR], –0.425, P = 0.038) and spinal herniation level (OR, –0.925, P = 0.001) and treatment success. Limitations: Our study’s design was retrospective. Conclusions: Cervical ILESI is a reliable treatment option that provides a significant reduction in pain of patients with cervical radiculopathy. However, the success of ILESI treatment may be negatively affected in these patients in the presence of high spinal level cervical disc herniation and severe foraminal stenosis. Therefore considering these 2 parameters in predicting the patient population who will benefit from cervical ILESI is of importance in terms of decreasing potential complications. Key words: Interlaminar epidural steroid injections, foraminal stenosis, spinal level, cervical disc herniation, radicular pain

scholarly journals Three-level cervical disc herniation

2015 ◽  
Vol 29 (3) ◽  
pp. 309-315
Author(s):  
Andrei St. Iencean ◽  
Ion Poeata
Keyword(s):  
Cervical Spine ◽  
Disc Herniation ◽  
The Elderly ◽  
Cervical Disc Herniation ◽  
Herniated Disc ◽  
Cervical Disc ◽  
Disc Disease ◽  
Degenerative Disc ◽  
Spine Pathology ◽  
Rapid Relief

Abstract Multilevel cervical degenerative disc disease is well known in the cervical spine pathology, with radicular syndromes or cervical myelopathy. One or two level cervical herniated disc is common in adult and multilevel cervical degenerative disc herniation is common in the elderly, with spinal stenosis, and have the same cause: the gradual degeneration of the disc. We report the case of a patient with two level cervical disc herniation (C4 – C5 and C5 – C6) treated by anterior cervical microdiscectomy both levels and fusion at C5 – C6; after five years the patient returned with left C7 radiculopathy and MRI provided the image of a left C6 – C7 disc herniation, he underwent an anterior microsurgical discectomy with rapid relief of symptoms. Three-level cervical herniated disc are rare in adults, and the anterior microdiscectomy with or without fusion solve this pathology.

scholarly journals Comparative Evaluation of Posterior Percutaneous Endoscopic Cervical Discectomy Using 3.7mm Endoscopic and 6.9mm Endoscopic for Cervical Disc Herniation: a retrospective comparative cohort study. 

2020 ◽  
Author(s):  
Tong Yu ◽  
Jiu-Ping Wu ◽  
Jun Zhang ◽  
Hai-Chi Yu ◽  
Qinyi Liu
Keyword(s):  
Spinal Cord ◽  
Clinical Outcomes ◽  
Disc Herniation ◽  
Large Diameter ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Foraminal Stenosis ◽  
Cervical Discectomy ◽  
Significant Difference ◽  
Cord Injury

Abstract Background. Posterior percutaneous endoscopic cervical discectomy (p-PECD) is an effective strategy for cervical diseases which working cannula ranges from 3.7 mm to 6.9 mm. However, no studies were performed to compare the clinical outcomes of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of unilateral CDH patients treated with p-PECD applying the 3.7mm endoscopic with those treated with the 6.9mm endoscopic. Methods. From January 2016 to June 2018, totally 28 consecutive patients presented with single-level CDH who received p-PECD using the 3.7mm or the 6.9mm endoscopic were enrolled. The indications for this study were as follows: (1) Unilateral cervical spondylotic radiculopathy with pain irradiated to upper extremity, (2) MRI and CT scan show that foraminal CDH located lateral to the edge of spinal cord, from C4–C5 to C7–T1, (3) Unilateral symptoms caused by foraminal stenosis, (4) Failure after conservative treatment for at least 6 weeks or neurological symptoms aggravated. The clinical outcomes, including the operation time, the hospitalization, the visual analogue scale (VAS) and the modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were performed during follow up.Results. The mean surgical duration of the 3.7mm endoscopic was 76.5 minutes compared with 61.5 minutes for 6.9mm endoscopic (P<0.05). Moreover, there was significant difference with regard to average identification time of “V” point (18.608±3.7607min vs. 11.256±2.7161min, p＜0.001) and mean removal time of overlying tissue (16.650±4.1730 min vs. 12.712±3.3079 min, p＜0.05) between 3.7mm endoscopic and 6.9mm endoscopic. The VAS and MacNab scores postoperatively of the two endoscopies were significantly improved compared with that before operation (p＜0.05).Conclusion. Both 3.7mm endoscopic and 6.9mm endoscopic are effective methods for CDH in selected patients, and there is no significant difference in clinical outcomes. 6.9mm endoscopic is superior to 3.7mm endoscopic in the efficiency of “V” point identification, overlying soft tissue removal and spinal cord injury prevention. Furthermore, 6.9mm endoscopy may be inferior to 3.7mm endoscopy in anterior decompression of foramina due to its large diameter, which needs to be further evaluated by a large number of randomized controlled trials.

scholarly journals Prospective Multicenter Trial of Cervical Arthroplasty With the ROTAIO® Cervical Disc Prosthesis

2021 ◽  
Author(s):  
Steffen Fleck ◽  
Anna Maria Lang ◽  
Jens Lehmberg ◽  
Julia Fee Landscheidt ◽  
Rüdiger Gerlach ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Success Rate ◽  
Cervical Disc ◽  
Foraminal Stenosis ◽  
Life Questionnaire ◽  
Disc Prosthesis ◽  
Disc Disease ◽  
Efficient Treatment ◽  
Arm Pain ◽  
Cervical Disc Prosthesis

Abstract ObjectiveAnterior Cervical Discectomy and Arthroplasty (ACDA) is an established treatment for degenerative cervical disc disease and seems to be an alternative to fusion in minimizing the risk of Adjacent Segment Disease (ASD). The ROTAIO® cervical disc prosthesis is a novel unconstrained implant with a variable center of rotation aiming at physiological motion. The objective of this multicenter prospective trial was to evaluate clinical outcome and complications within 2 years.Material and Methods120 patients (72 females and 48 males with a median age of 43.0 years; range: 23 to 60 years) underwent ACDA (ROTAIO®, SIGNUS Medical, Alzenau, Germany) and were prospectively followed for 24 months. Preoperative complaints were mainly associated with radiculopathy (n=104) or myelopathy (n=16). There were 108 monosegmental and 12 bisegmental procedures including 6 hybrid constructs. Clinical outcome was evaluated at 3, 12 and 24 months by the Visual Analogue Scale (VAS) for head, neck and arm pain, the Neck Disability Index (NDI), the Work Limitation Questionnaire (WL-26), the Patient`s Satisfaction Index (PSI) and a Quality of Life Questionnaire (SF-36). The Nurick Score, the Modified Japanese Orthopaedic Association Score (mJOA) plus a Composite Success Rate have been additionally applied. Finally, complications, the patient`s overall satisfaction and the amount of analgesics were assessed. ResultsHighly significant clinical improvements were observed according to NDI and VAS (p<0.0001 (arm); p<0.001 (neck); p=0.002 (head)) at all postoperative time points. Analgetic medication could be reduced after 3 months in 91.3%, after 12 months in 87.1% and after 24 months in 95.2% of patients. Doctor`s visits for cervical spine problems have been reduced in 93.8% after 24 months.Patient`s overall satisfaction was high after 3, 12 and 24 months with 83.5%, 78.4% and 79.1% of patients, while 4.1%, 6.8% and 7.0% respectively were not satisfied. The composite success rate was 77.5% after 12 months and 76.9% after 24 months. There were no major complications in this series. Slight subsidence of the prosthesis was observed in 2 patients and 3 patients demonstrated fusion after 24 months. 2 patients developed symptomatic foraminal stenosis, so that implant removal and fusion was performed.ConclusionThe ROTAIO® cervical disc prosthesis is a safe and efficient treatment option for symptomatic degenerative disc disease demonstrating excellent clinical results at 2 years. Outcome proves to be stable over time with very low revision rates.

scholarly journals Biomechanical Effects of Lateral Bending Position on Performing Cervical Spinal Manipulation for Cervical Disc Herniation: A Three-Dimensional Finite Element Analysis

2018 ◽  
Vol 2018 ◽  
pp. 1-8 ◽  
Author(s):  
Xuecheng Huang ◽  
Linqiang Ye ◽  
Zixian Wu ◽  
Lichang Liang ◽  
Qianli Wang ◽  
...  
Keyword(s):  
Finite Element ◽  
Disc Herniation ◽  
Spinal Manipulation ◽  
Facet Joint ◽  
Cervical Disc ◽  
Disc Displacement ◽  
Neutral Position ◽  
Fe Model ◽  
Lateral Bending ◽  
Fiber Stress

Background. Most studies report that the common position of cervical spinal manipulation (CSM) for treating symptomatic cervical disc herniation (CDH) is lateral bending to the herniated side. However, the rationality of lateral bending position on performing CSM for CDH is still unclear. Objective. The purpose of this study is to investigate the biomechanical effects of lateral bending position on performing CSM for CDH. Methods. A finite element (FE) model of CDH (herniated on the left side) was generated in C5-6 segment based on the normal FE model. The FE model performed CSM in left lateral bending position, neutral position, and right lateral bending position, respectively. Cervical disc displacement, annulus fiber stress, and facet joint stress were observed during the simulation of CSM. Results. The cervical disc displacement on herniated side moved forward during CSM, and the maximum forward displacements were 0.23, 0.36, and 0.45 mm in left lateral bending position, neutral position, and right lateral bending position, respectively. As the same trend of cervical disc displacement, the annulus fiber stresses on herniated side from small to large were 7.40, 16.39, and 22.75 MPa in left lateral bending position, neutral position, and right lateral bending position, respectively. However, the maximum facet stresses at left superior cartilage of C6 in left lateral bending position, neutral position, and right lateral bending position were 6.88, 3.60, and 0.12 MPa, respectively. Conclusion. Compared with neutral position and right lateral bending position, though the forward displacement of cervical disc on herniated side was smaller in left lateral bending position, the annulus fiber stress on herniated side was declined by sharing load on the left facet joint. The results suggested that lateral bending to the herniated side on performing CSM tends to protect the cervical disc on herniated side. Future clinical studies are needed to verify that.

scholarly journals Cervical disc arthroplasty at C2–3: illustrative case

2021 ◽  
Vol 2 (5) ◽  
Author(s):  
Jason Ku ◽  
Johnson Ku ◽  
Hsuan-Kan Chang ◽  
Jau-Ching Wu
Keyword(s):  
Disc Herniation ◽  
Magnetic Resonance Images ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Cervical Disc Arthroplasty ◽  
Illustrative Case ◽  
Viable Option ◽  
Disc Disease ◽  
Disc Arthroplasty ◽  
Arm Pain

BACKGROUND Since the beginning of the 21st century, cervical disc arthroplasty (CDA) has been accepted as an alternative to anterior cervical discectomy and fusion for surgical management of disc problems. The published clinical trials of CDA have included patients with radiculopathy or myelopathy caused by one- or two-level disc herniation at C3–7. However, it remains uncertain whether CDA is a viable option for C2–3 disc herniation. OBSERVATIONS In this report, a 52-year-old man presented with hand numbness, arm pain, and myelopathic symptoms that were refractory to medical treatment for more than 6 months. The magnetic resonance images demonstrated herniated discs at C2–3, C3–4, and C4–5, causing stenosis. There was no ossification of posterior longitudinal ligament and the spine was mobile, so he received anterior discectomies with artificial disc replacement at each of the C2–3, C3–4, and C4–5 levels. The surgery went smoothly, and his neurological symptoms were promptly relieved. The postoperative radiographs at 24 months demonstrated a preserved range of motion at each level. LESSONS To date, this was the first report of CDA performed at C2–3, which also involved three consecutive levels of disc replacement. The report suggested that both C2–3 and three-consecutive-level CDA may be a viable option for cervical disc disease.

scholarly journals Comparative Evaluation of Posterior Percutaneous Endoscopic Cervical Discectomy Using 3.7mm Endoscopic and 6.9mm Endoscopic for Cervical Disc Herniation: a retrospective comparative cohort study.

2020 ◽  
Author(s):  
Tong Yu ◽  
Jiu-Ping Wu ◽  
Jun Zhang ◽  
Hai-Chi Yu ◽  
Qinyi Liu
Keyword(s):  
Spinal Cord ◽  
Clinical Outcomes ◽  
Disc Herniation ◽  
Operation Time ◽  
Cervical Disc Herniation ◽  
Cervical Disc ◽  
Foraminal Stenosis ◽  
Cervical Discectomy ◽  
Significant Difference ◽  
Cord Injury

Abstract Background. Posterior percutaneous endoscopic cervical discectomy (p-PECD) is an effective strategy for cervical diseases which working cannula ranges from 3.7 mm to 6.9 mm. However, no studies were performed to compare the clinical outcomes of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of unilateral CDH patients treated with p-PECD applying the 3.7mm endoscopic with those treated with the 6.9mm endoscopic. Methods. From January 2016 to June 2018, totally 28 consecutive patients presented with single-level CDH who received p-PECD using the 3.7mm endoscopic or the 6.9mm endoscopic were enrolled. The indications for this study were as follows: (1) Unilateral cervical spondylotic radiculopathy with pain irradiated to upper extremity, (2) MRI and CT scan show that foraminal CDH located lateral to the edge of spinal cord, from C4–C5 to C7–T1, (3) Unilateral symptoms caused by foraminal stenosis, (4) Failure after conservative treatment for at least 6 weeks or neurological symptoms aggravated. Patients were evaluated neurologically pre- and postoperatively. The clinical outcomes, including the operation time, the hospitalization, the visual analogue scale (VAS) and the modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were performed during follow up.Results. The mean surgical duration of the 3.7mm endoscopic was 76.5 minutes compared with 61.5 minutes for 6.9mm endoscopic (P<0.05). Moreover, there was significant difference with regard to average identification time of “V” point (18.608±3.7607min vs. 11.256±2.7161min, p＜0.001) and mean removal time of overlying tissue (16.650±4.1730 min vs. 12.712±3.3079 min, p＜0.05) between 3.7mm endoscopic and 6.9mm endoscopic. The VAS and MacNab scores postoperatively of the two endoscopies were significantly improved compared with that before operation (p＜0.05).Conclusion. Both 3.7mm endoscopic and 6.9mm endoscopic are effective methods for CDH in selected patients, and there is no significant difference in clinical outcomes. 6.9mm endoscopic is superior to 3.7mm endoscopic in the efficiency of “V” point identification, overlying soft tissue removal and spinal cord injury prevention. Furthermore, 6.9mm endoscopic is inferior to 3.7mm endoscopic in anterior decompression of the intervertebral foramen.

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