Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation: outcome, complications, and technique.

STUDY

DESIGN

Clinical study of percutaneous endoscopic surgery for cervical intervertebral disc herniation (CHIVD).

OBJECTIVES

Our aim was to evaluate the efficacy of anterior percutaneous endoscopic cervical discectomy (APECD), previously known as percutaneous endoscopic cervical discectomy, for CHIVD. In addition, the ways to avoid major complications, including case selection and surgical techniques, are highlighted.

SUMMARY OF BACKGROUND DATA: CHIVD is a common disease and can cause cervical radiculopathy, namely, radiating arm pain, numbness or weakness of the upper extremity, or myelopathy. If conservative treatment failed, most patients were treated by anterior cervical discectomy and fusion.

METHODS

From October 2002 to July 2008, a total of 107 consecutive patients with clinically symptomatic CHIVD who underwent APECD were enrolled. The clinical outcomes were evaluated using the visual analog scale, Neck Disability Index, and modified MacNab criteria. Radiographic follow-up included static and dynamic plain cervical radiographs and magnetic resonance imaging.

RESULTS

Eighty-six patients (80%) could be followed up for at least 12 months (range: 12 to 60 mo; mean, 22.4 mo) for outcome evaluation. The visual analog scale and Neck Disability Index improved significantly (P<0.001) after the operation. According to the modified MacNab criteria, excellent and good outcome were achieved in 29 (34%) and 49 (57%) patients, respectively. Two patients (2 of 107, 2%) experienced operation-related complications: 1 patient sustained carotid artery injury and was treated with angiographic stenting, whereas the other patient had postoperative headache and recovered after conservative treatment.

CONCLUSIONS

APECD is not only minimally invasive but can also avoid the morbidities of conventional open cervical discectomy. Patients have a more rapid postoperative recuperation. Nevertheless, it carries the risk of major complications. With careful patient selection and use of meticulous surgical techniques, it is still a safe and effective alternative to open surgical modalities for CHIVD.