Percutaneous Endoscopic Cervical Discectomy and Osteophytes Removal Via an Anterior Transforaminal Approach for Radiculopathy: Technical Notes and Review

Abstract

BACKGROUND: Cervical radiculopathy can be treated by anterior endoscopic approach to access its target pathology decompressing spinal nerve roots without fusion. The transforaminal anterior percutaneous endoscopic cervical discectomy approach is easy way to transverse process and decompress and remove osteophytes. It preserves spinal motion, stability and reduces risk of vertebral injury. METHODS: A case selected had neck pain radiating toward right arm for 2 month but severe pain from 20 days, neck deformities, head tilted toward right side. Neurological examination showed decreased sensation, weakness over right sided trapezius, biceps and triceps muscles. Eaton sign and Spurling sign were positive. Preoperative dynamic X-ray showed degenerative changes, osteophtyes at C3-4, C5-6, CT -intervertebral foraminal stenosis at C3-4 and C5-6 level, MRI -disc protrusion severely compressing spinal cord at C3/4 level. We operated at most significant level as first successful newer approach for cervical radiculopathy with osteophytes removal, decompression and discectomy by PECD anterolateral (transforaminal approach) under general anesthesia. RESULTS: Blood loss 100 mL. Hospital Stay 3 days. Operative time was 80 minute. There was marked improvement of preoperative VAS score from 7/10 to 3/10. After surgery drain was fixed for 24 hour to collect some residual fluids and avoid hematomas. There were no significant post operative events or surgery-related complication. CONCLUSION: Under percutaneous endoscopic system is easy to visualize proper minute structure, drill, dissect and lessen the chance of iatrogenic injury, decrease risk of vertebral arteries. Anterior transformaminal endoscopic surgical approach can be further developed and trained for treatment of cervical radiculopathy in large population.