Abstract
BackgroundCompared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH).MethodsFour patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation.ResultsThe average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative.ConclusionThis is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure.Trial registrationNumbers: ChiCTR1800016383. Registered 29 may 2018. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry.
Highlights
Compared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH)
Cervical disc herniation (CDH) is a degenerative disease of the cervical spine in which the lesion induces a series of symptoms due to an oppressed spinal cord
Anterior cervical discectomy and fusion (ACDF) has become the standard surgical procedure for single- and multiplelevels degenerative cervical spine diseases due to its excellent clinical results and good fusion rates since it was introduced by Smith and Robinson and Cloward in the 1950s [1, 2]
Summary
Compared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH). Anterior transcorporeal discectomy (ATH) was first reported by George in a study that treated lesions in the cervical spinal canal [19], and was derived from a reformation of the technique of Verbiest and Hakuba et al [20,21,22,23,24]. The transcorporeal technique retains the cervical motion segment, protects the disc from surgical damage and has been modified by several surgeons since its introduction [25,26,27,28,29,30]. An operating microscope was used in their procedure to improve surgical vision, cause less damage to soft tissues and increase the safety of the manipulation
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