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

Abstract

Cervical foraminotomy is a popular procedure with surgeons to treat patients with refractory cervical radicular pain. Traditionally, it has been performed from the posterior approach. With the advent of minimally invasive spinal surgery techniques (MISST), anterior methods have also been employed to approach the compressive pathology from the axilla of the painful cervical nerve root. The authors of this chapter present their technique of transdiscal endoscopic anterior cervical discectomy foraminoplasty using an instrument system comprised of serial dilators, trephines, rongeurs, and a pulsed radiofrequency probe. They demonstrate the steps of the procedure from patient positioning, placement of surgical access, the employment of the individual surgical instruments, and their clinical outcomes. The authors briefly describe their clinical experience over a twenty-one year period. They performed a total of 232 procedures on 169 patients with single and up to 4 level surgeries herniate disc (219/232; 94.39%). An additional 13 patients (4.9%) had procedures for the treatment of lateral cervical canal stenosis. At a one-year follow-up, 90% of patients were rated to have had Excellent and Good Macnab outcomes, whereas Fair and Poor results were reported by 7%, and 3% of patients, respectively. In the absence of intraoperative or postoperative complications or reoperations associated with the procedure, the authors recommended it as a simplified outpatient alternative to anterior cervical discectomy and fusion.