A Novel Technique of Endoscopic Anterior Transcorporeal Approach with Channel Repair for Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion

Abstract

To first report the application of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) with channel repair for a patient with adjacent segment disease (ASD) after anterior cervical discectomy and fusion. PEATCD with channel repair was performed for a patient with ASD at the cranial level adjacent to previous fusion at the C5-C6 level. The pre- and postoperative clinical symptoms were evaluated with Japanese Orthopedic Association and visual analog scale (VAS). The radiological examinations included magnetic resonance imaging, computed tomography, and plain radiographs, which were used to evaluate the cervical alignment, stability, intraoperative decompression, and bony channel. The procedure was successfully completed within 70 minutes. The drainage tube was unnecessary. No surgery-related complications were recorded. The postoperative neck pain immediately improved to VAS 3 from preoperative VAS 6. The Japanese Orthopedic Association scores also took a turn for the better gradually from preoperative 10 to final 16 (improvement rate 85.7%). The muscle power recovered completely, and the Hoffman sign turned to negative during follow-up periods. Magnetic resonance imaging 1 week postoperatively showed a total removal of the herniation. The bony channel was almost disappeared on computed tomography images 3 months postoperatively. During postoperative periods, no relapse, channel collapse, bone plug migration, or instability was observed. As a novel and supplemental procedure for ASD after anterior cervical discectomy and fusion, PEATCD combines the advantages of transcorporeal approach and endoscopy together, which decreases iatrogenic damage to disc, preserves the cervical motion segment, and reduces surgical trauma. As the limitations of 1 case show, the effectiveness and reliability of PEATCD for patients with ASD should be verified in further studies.