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

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

Headache due to Bilateral Subacute Subdural Hematomas following Intracranial Hypotension Caused by Cervical Disc Herniation

Spontaneous intracranial hypotension (SIH) is caused by spinal leakage of cerebrospinal fluid (CSF) and typically causes orthostatic headache which is relieved by lying in a recumbent position. We describe the case of a 44-year-old male suffering from orthostatic headaches accompanied by symptomatic cervical disc herniation, for which he had an anterior cervical discectomy and fusion (ACDF). Computerized tomography of the brain at the emergency department 1 week after this procedure showed bilateral subacute subdural hematomas. In retrospect, the positional headache had been present for 3 months prior to the ACDF, and magnetic resonance imaging of the cervical spine prior to the ACDF already showed signs of an extradural CSF collection indicating intracranial hypotension. This case highlights the possibility of SIH caused by a spinal dural leak due to cervical disc herniation.

Effects on pain of percutaneous treatment of cervical disc herniations using DiscoGel: A retrospective analysis

Background and purpose Cervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose. Material and methods Between March 2018 and April 2019 we performed this procedure on 38 patients with non-fissurated cervical herniation using 0.3–0.4 mL of DiscoGel injected under fluoroscopic guidance. The most common discs affected were C5–C6, C6–C7 and C4–C5. Outcomes were evaluated with Visual Analogue Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) scores at 3, 6 and 12 months follow-up. A magnetic resonance imaging (MRI) scan of the cervical spine was performed 3 months after the procedure. Results Postoperative examinations showed: VAS 2.15 ± 1.34 and NPSI 2.29 ± 0.71. Postoperative MRI performed 3 months after the procedure showed a good improvement of cervical disc herniation or bulging or protrusion. The mean dose area product (DAP) was 2803 mGy/cm2 with a mean fluoroscopy time of 4 minutes 22 seconds. Conclusion DiscoGel is a suitable approach for non-fissurated cervical disc herniations, especially in patients that are not suitable for open surgery, with excellent postoperative results, fast recovery and a low radiation dose.