Anterior Endoscopic Cervical Discectomy Research Articles

A comprehensive review on anterior endoscopic cervical discectomy

Anterior endoscopic cervical discectomy (AECD) represents a groundbreaking surgical technique that has garnered considerable interest in recent times due to its minimally invasive nature for addressing cervical disc herniation. This review endeavours to conduct a thorough examination of the existing literature concerning AECD, encompassing its indications, surgical technique, clinical outcomes, advantages, limitations, and potential complications. Through a meticulous analysis of the available data, this review aims to evaluate the effectiveness, safety, and overall viability of AECD as a substitute for conventional open surgical methods in addressing cervical disc issues. By delving into these aspects, the review seeks to provide insights into the potential role of AECD in enhancing patient outcomes and optimizing the management of cervical disc pathology.

Surgeon reported practice patterns related to full endoscopic cervical decompression procedures.

The microsurgical anterior approach to the cervical spine is commonplace. Fewer surgeons perform posterior cervical microsurgical procedures on a routine basis for lack of indication, more bleeding, persistent postoperative neck pain, and risk of progressive misalignment. In comparison, the endoscopic technique is preferentially performed through the posterior approach. Many spine surgeons and even surgeons versed in lumbar endoscopy are often reluctant to consider endoscopic procedures in the cervical spine. We report the results of a surgeon survey to find out why. A questionnaire of 10 questions was sent to spine surgeons by email and chat groups in social media networks including Facebook, WeChat, WhatsApp, and LinkedIn to collect practice pattern data about microscopic and endoscopic spine surgery in the lumbar and cervical spine. The responses were cross-tabulated by surgeons' demographic data. Pearson Chi-Square measures, Kappa statistics, and linear regression analysis of agreement or disagreement were performed by analyzing the distribution of variances using the statistical package SPSS Version 27.0. The survey response rate was 39.7%, with 50 of the 126 surgeons who started the survey submitting a completed questionnaire. Of the 50 surgeons, 56.2% were orthopedic, and 42% neurological surgeons. Most surgeons worked in private practice (42%). Another 26% were university-employed, 18% were in private practice affiliated with a university, and the remaining 14% were hospital employed. The majority of surgeons (55.1%) were autodidacts. The largest responding surgeon groups were between 35-44years (38%) and between 45-54years of age (34%). Half of the responding surgeons were routinely performing endoscopic cervical spine surgery. The other half did not perform it for the main hurdle of fear of complications (50%). Lack of appropriate mentorship was listed as second most reason (25.4%). More concerns for not performing cervical endoscopic approaches were the perception of lack of technology (20.8%) and suitable surgical indication (12.5%). Only 4.2% considered cervical endoscopy too risky. Nearly a third (30.6%) of the spine surgeons treated over 80% of their cervical spine patients with endoscopic surgeries. Most commonly performed were posterior endoscopic cervical discectomy (PECD; 52%), posterior endoscopic cervical foraminotomy (PECF; 48%), anterior endoscopic cervical discectomy (AECD; 32%), cervical endoscopic unilateral laminotomy for bilateral decompression (CE-ULBD; 30%), respectively. Cervical endoscopic spine surgery is gaining traction among spine surgeons. However, by far most surgeons performing cervical endoscopic spine surgery work in private practice and are autodidacts. This lack of a teacher to shorten the learning curve as well as fear of complications are two of the major impediments to the successful implementation of cervical endoscopic procedures.

Anterior Endoscopic Cervical Discectomy: Surgical Technique and Literature Review.

The conventional surgical technique for radiculopathy with cervical disc herniation (CDH) is anterior cervical discectomy and fusion, with a good clinical outcome and fusion rate. However, significant perioperative morbidity related to extensive surgical exposure has been reported. Therefore, anterior endoscopic cervical discectomy (AECD) using a working channel endoscope has been developed to reduce surgical complications and tissue damage. The objective of this study was to describe a cutting-edge technique for AECD of soft CDH. The primary indication is cervical radiculopathy with or without axial neck pain due to soft CDH. The surgical procedure consists of 2 parts: (1) a safe anterior percutaneous approach under fluoroscopic control and (2) selective endoscopic discectomy and foraminal decompression using specialized mechanical tools under endoscopic visualization. The clinical outcomes are comparable to those of conventional surgery and show the benefits of minimally invasive spine procedure. Perioperative data revealed typical minimalism, including reduced muscle damage, blood loss, operative time, and recovery time. With technical advancements in surgical instruments and optics, AECD will become more practical and safer. AECD is effective in selected CDH cases with cervical radiculopathy. However, high-quality clinical studies are needed to verify the effectiveness of this endoscopic cervical spinal procedure.

Full Endoscopic Anterior Cervical Discectomy vs Anterior Cervical Discectomy with Fusion. A Systematic Review.

To assess, and to compare the efficacy of anterior endoscopic cervical discectomy (AECD) and anterior cervical discectomy with fusion (ACDF). Major databases, registries, and other relevant material were screened for prospective trials directly comparing AECD and ACDF. No restrictions were imposed. Meta-analysis was not conducted due to high heterogeneity. After screening a total of 1339 articles, 2 studies enrolling 225 patients were included. One of these is a randomizedcontrolled- trial, including 120 patients, with a 14% lost to follow-up, showing no statistically significant differences in clinical outcomes according to the visual analogue scale (VAS) of the neck/arm and the North American Spine Society criteria regarding pain/neurological status. Radiological follow-up showed no adjacent-segment disease, with both groups presenting a statistically non-significant progression of a pre-existing adjacent-disc degeneration, and no difference in kyphosis. Recurrence was registered in 7.4% and 6.1% of patients who underwent AECD and ACDF, respectively. No statistically apparent differences in complications were observed. The second is a cohort study, including 135 patients with a 14.8% lost to follow-up. No statistically significant difference was found in clinical outcomes assessed using the VAS of the neck/arm and the neck disability index. No radiological data were provided. Recurrence was reported in 4% and 2% of patients in the AECD and ACDF group, respectively. No remarkable differences in complications were reported. Both studies reported that the surgical time was statistically shorter in AECD. A definitive conclusion cannot be drawn. Single-level AECD seems to have results equivalent to ACDF, presenting even some benefits. Technical limitations combined with required surgical skills and experience should be considered. We recommend cautious employment in anticipation of future updates.

Peer review of the book Bentham Science Publishers eBook* Contemporary Endoscopic Spine Surgery Volume 1: Cervical Spine edited by Kai-Uwe Lewandrowski, Jorge Felipe Ramírez León and Anthony Yeung

In the book ”Contemporary Endoscopic Spine Surgery”, edited by Kai-Uwe Lewandrowski, Jorge Felipe Ramírez León, and Anthony Yeung, information on the history of spinal endoscopy is provided. A number of aspects of spinal surgery are covered, in particular spinal pain, preoperative examination, indications for endoscopic surgery, anesthesia, outpatient surgery. New endoscopic technologies are described. Leading scientists presented the clinical results of spinal surgery. Information on endoscopic surgery of degenerative diseases of the spine (herniated cervical discs, stenosis, instability, spinal deformities) is provided. The monograph contains three volumes ("Cervical spine", "Lumbar spine" and "Modern technologies"). The volume "Cervical spine" covers the following topics: - endoscopy of the cervical spine: historical perspectives, present and future; - anesthesia for minimally invasive surgery of the cervical spine; - algorithms for choosing between anterior and posterior endoscopy of the cervical spine; - making clinical decisions full endoscopy of the cervical spine; - spine surgery: indications for and results of endoscopic posterior cervical rhizotomy; anterior endoscopic cervical discectomy; anterior transcorporeal approach to percutaneous endoscopy of the cervical spine; - discectomy: anterior endoscopic cervical discectomy and foraminoplasty for disc herniation and cervical spinal stenosis; posterior full endoscopic discectomy and foraminotomy; endoscopic decompression in cervical spondylogenic myelopathy. The publication can be useful for both neurosurgeons-interns and practicing neurosurgeons to expand their understanding of spinal endoscopic surgery.