Cervical Soft Disc Research Articles

Ultrasound-guided Percutaneous Laser Disc Decompression (PLDD) with Fluoroscopic Validation for the Treatment of Cervical Disc Herniation: Technical Note.

Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. Technical note. We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach. We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound guidance for the treatment of contained cervical disc herniation using a 1,470 Nm diode laser. The lower cervical discs (C5-C6 and C6-C7) were the most affected sites, accounting for 78.6% of surgical discs. A significant NRS reduction between baseline and 1 month (P = .0002) and between baseline and 12 months (P = .0007) was observed. Our results support the conclusion that ultrasound guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US.

Usefulness of rheumatology consultancy in situ: Analysis of a long-term experience

ObjectiveTo report the long-term experience of a rheumatologist consultant “in situ” (RCI) in a primary care centre (PCC). Material and methodsObservational retrospective study analysing the complete cohort of the patients seen by the RCI between 2013 and 2019. Rheumatology patients’ clinical characteristics and course of care were collected to estimate the diagnoses that were most likely to be monitored by a primary care physician (PCP). ResultsA total of 876 consultations were attended; 205 were men (23.4%) and 671 women (76.6%).Most of the consultations (280, 33.2%) were diagnostic. On 167 occasions (19.8%) therapeutic issues were analysed; in 47 (5.6%) therapeutic infiltrations were performed. Chronic patient control was applied in 163 subjects (19.3%). A request for tests not available to the PCP was the reason for the consultation in 154 situations (18.3%). The profile most likely to continue being monitored in the PCC is the patient with osteoarthritis (OR = .13, CI 95%: .02–.67), soft tissue rheumatism (OR = .006, 95% CI: .01–.45) or cervical disc herniation (OR = .13, 95% CI: .02–.66). Less likely to be monitored by PCP after being seen by the RCI were subjects with rheumatoid arthritis (OR = .03, 95% CI: .00–.24), other inflammatory arthropathies (OR = .36, 95% CI: .16–.80) or with polymyalgia rheumatica (OR = .19, 95% CI: .06-.64 ), and those in need of chronic disease monitoring (OR = .16, 95% CI: .07–.34). ConclusionsThe RCI makes it easier for the PCP to monitor patients with osteoarthritis, soft tissue rheumatism and cervical disc pathology.

Posterior cervical sequestrectomy via keyhole foraminotomy: a case series comparing microdiscectomy with endoscope assisted discectomy

To report the clinical outcomes of microdiscectomy (MD) and endoscope assisted discectomy (EAD) techniques via the posterior approach in patients with cervical disc herniations (CDHs). The data were obtained from retrospective review of the patient?s charts and the latest follow-up examination. A total of 83 cases with CDH who were treated by posterior cervical discectomy (PCD), between 2010 and 2019, were reviewed. MD was used in 42 patients (male: 20, female: 22) with a mean age of 51.1 years. In MD group, all patients had pain, and 26 of them had additional weakness. Visual analogue scale (VAS) neck score was 7.72, VAS arm score was 8.83; PROLO score was 7.41. EAD was used in 41 patients (male: 26, female: 15) with a mean age of 38.7 years. In EAD group, all patients had pain, and 20 of them had additional weakness. VAS neck and arm scores were 7.75, and 8.72, respectively; PROLO score was 7.44. Mean follow-up time was 24.7 months. The scores at the latest exam are as follows: in MD group, VAS score for neck was 2.32, for arm 1.11; PROLO score was 9.58; in EAD group, VAS score for neck was 2.18 and for arm 0.97; PROLO score was 9.66. Both surgical techniques were success with statically significance (p?0.05) according to the scores.The techniques were equally effective while postoperative VAS (p > 0.412) and PROLO (p > 0.980) scores were similar in both groups. Both approaches are effective for selected patients with soft cervical disc herniation in which settled lateral location. Both techniques allow working with two handle, therefore facilitating the gentle manipulation that can obtain for avoiding hazardous effect to spinal cord and nerve root.

Percutaneous Endoscopic Cervical Discectomy Versus Anterior Cervical Discectomy and Fusion: A Comparative Cohort Study with a Five-Year Follow-Up.

Percutaneous endoscopic cervical discectomy (PECD) is an effective minimally invasive surgery for soft cervical disc herniation in properly selected cases. The current gold standard is anterior cervical discectomy and fusion (ACDF). However, few studies have evaluated the outcome of PECD compared with ACDF. We compared the surgical results of PECD and ACDF. Data from patients treated with single-level PECD (n = 51) or ACDF (n = 64) were analyzed. Patients were prospectively entered into the clinical database and their records were retrospectively reviewed. Perioperative data and clinical outcomes were evaluated using the visual analogue scale (VAS), Neck Disability Index (NDI), and modified Macnab criteria. VAS and NDI results significantly improved in both groups. The rates of excellent or good results were 88.24% and 90.63% in the PECD and ACDF group, respectively. The revision rates were 3.92% and 1.56% in the PECD and ACDF group, respectively. Operative time, hospital stay, and time to return to work were reduced in the PECD group compared to the ACDF group (p < 0.001). The five-year outcomes of PECD were comparable to those of conventional ACDF. PECD provided the typical benefits of minimally invasive surgery and may be an effective alternative for treating soft cervical disc herniation.

Anterior Surgery of Hard and Soft Cervical Disc

AbstractBackground: Anterior access cervical surgery aims to remove the compressing agent which might be soft disc material or bony spur this offender material is the cause of patient complaint which might be electrical like pain or, numbness in one upper limb or both.Anterior cervical surgery of hard & soft disc aims towards the excision of the bony osteophyte or disc material that is compressing the nerve root causing electrical, numbness, or shooting pain, that often begins in the neck & travels into one or both shoulders and arms.Aim of Study: To compare the results of ACDF using cages for interbody fusion in both soft and hard cervical discs extractions regarding the difference in surgical time, loss of blood, post-operative hospital stay, relief of presenting symp-toms, the incidence of complications & return to regular work.Patients and Methods: This is a, retrospective. Study of 21 patients with the diagnosis of cervical disc prolapse operated upon by ACDF with cages instrumentation in the period from 5/2012-5/2015 in the Department of Neurosurgery, Beni Sueif University.Cases were divided, into 2 groups:•Group A: 14 patients with (single/double) levels soft cervical discs.•Group B: 7 patients with (single/double) levels hard cervical discs.Results: 21 cases were included in this series. The mean age was 35 in group (A) and 49 in group (B), there were six females, and 15 were males. 14 patients had single level discs, and seven patients had two levels.Operative time was to some extent longer in hard disc cases than soft disc cases. Also, blood loss was somewhat more in hard disc than soft disc patient satisfaction is equal in the two groups; but return to regular work was after eight weeks in the hard disc in comparison to 6 weeks in soft disc period of follow-up was six month of both groups showing no difference in the outcome.Conclusion: Although ACDF for hard cervical discs requires longer, operative time and may cause more loss of blood & more delayed return to regular work when compared to the soft discs, the clinical outcome during six months follow-up period showed no difference between the 2 groups.

Spontaneous Regression of the Sequestrated Cervical Discs: A Prospective Study of 70 Cases

The validity of conservative management in certain type of acute cervical disc herniation based on amelioration of brachialgia has been described previously. But, disappearance of radiculopathy secondary to spontaneous resolution of the disc material being demonstrated in control MRI has been sporadically reported as a case report or small series. Herein we will describe 70 carefully selected patients with acute mono-radiculopathy due to cervical soft disc herniation. These cases were enrolled in a prospective study for the possibility of their spontaneous resolution with time. For the possibility spontaneous resolution of the sequestrated disc material, periodic MRI was used. In parallel, pain intensity at the onset and its intensity at the time of its complete resolution were assessed via Visual Analogue Scale (VAS). Mixed-design repeated measures ANOVA and independent sample T-test were carried out to determine the effects of this kind of treatment on pain intensity and ultimate outcome of the patients. Surprisingly, spontaneous resolution of the sequestrated disc material was observed in control MRI, in all 70 recruited patients, in duration with mean of 5.71 ± 1.49 months. Furthermore, despite severity of the pain at the onset, amelioration of radiculopathy occurred with significant decrease in VAS score with initial intensity from mean of 9.30 ± 0.80 to mean of 0.90 ± 0.76, after disappearance of the offending disc material. The details of the current series which is the first prospective one in the literature might offer a strong clue about the validity of conservative management in certain type of acute cervical disc herniation. The current report may advocate the neurosurgeons to allow the nature to resolve its problem with its own alterations in due time in sequestrated cervical disc herniation’s in the absence of neurological deficit.

STITCHLESS Percutaneous Endoscopic Cervical Discectomy: Are We Moving Towards Day Care Discectomy Procedure?

Background:STITCHLESS percutaneous endoscopic cervical discectomy s[PECD] is safe, precise, targeted, and a complete endoscopic procedure to treat soft cervical disc herniation with unilateral radiculopathy. It allows direct visualization of herniated fragment and its removal, inspection of decompressed nerve root in an awake and aware patient. It reduces the risk related to general anesthesia and to the neurological structures. However, all the patients treated with PECD can be candidates for anterior cervical discectomy and fusion (ACDF). ACDF requires a longer period of stay, expense, and more risk to neurological structures and ultimately loss of the disc space by fusion.Materials and Methods:Twenty consecutively treated patients by sPECD over a period of 2 years with soft cervical disc herniation and unilateral radiculopathy were included in the study. PECD enables removal of offending fragment under vision and irrigation and ablation of inflammation with few complications. All patients were followed for minimum of 6 months with visual analog score (VAS) and neck disability index (NDI).Results:All treated patients had a good outcome in terms of pain relief (VAS) and functional recovery (NDI). One patient had episodes of cough lying in the supine position and another patient had transient hoarseness of voice, (both recovered).Conclusion:Potential benefits of sPECD include safety as it is done under local anesthesia, smaller incision, short hospitalization, fewer complications, avoidance of fusion, preservation of segmental motion, preventing the adjacent segment degeneration, and avoidance of the risk related to the hardware (nonunion and pseudarthrosis). sPECD is an effective treatment modality for soft cervical disc herniation.

Comparison of Surgical Results between Soft Ruptured Disc and Foraminal Stenosis Patients in Posterior Cervical Laminoforaminotomy.

ObjectivePosterior cervical laminoforaminotomy is used to relieve cervical nerve root compression caused by a laterally herniated soft cervical disc or spondylotic spur and its several advantages and disadvantages compared with anterior cervical discectomy were reported. We compared surgical results between soft ruptured disc and foraminal stenosis in posterior cervical laminoforaminotomy.MethodsWe performed a retrospective review of 47 patients performed single level posterior cervical laminoforaminotomy for cervical radiculopathy between 2004 and 2012. We divided these patients into two groups, Group A: 27 patients for ruptured disc and Group B: 20 patients for foraminal stenosis and analyzed the demographic factors, amount of medial facetectomy, postoperative instability with neck pain and clinical outcomes.ResultsAccording to the modified Odom's criteria, laminoforaminotomy for the ruptured disc showed 92.6% excellent results and 7.4% good results. For the foraminal stenosis, it was 55.0% excellent and 25.0% good results, which was statistically significant. However when both groups were included, overall success rate showed 91.5%. The extent of medial facetectomy for ruptured disc (31.2%) was smaller than for stenosis (48.8%) and it was statistically significant. Thirteen patients complained of postoperative neck pain for 2 months. There was no instability on dynamic X-ray until the last follow up period and we had two cases complications (4.3%).ConclusionAlthough the extent of facetectomy for ruptured disc was smaller than it for stenosis, posterior laminoforaminotomy for the ruptured disc showed the better outcomes than foraminal stenosis.

Return to Sports After Cervical Total Disc Replacement

Total disc replacement (TDR) is typically indicated in young patients with a cervical soft disc herniation. There are few data on the activity level of patients after cervical TDR, in particular from young patients who are expected to have a high activity level with frequent exercising. The expectation is that returning to active sports after cervical TDR is not restricted. Fifty patients were treated with a monosegmental cervical TDR at our department between May 2006 and March 2012. Clinical status and radiographic parameters were evaluated preoperatively and during follow-up. In addition, information was gathered regarding neck disability index, pain, a questionnaire concerning athletic aspects, and a modified Tegner activity score. The study design was a prospective case series. All patients were treated with the Prestige artificial cervical disc for a single-level soft disc herniation with radiculopathy. The average age was 40 years, and the mean follow-up period was 53 months (range, 26-96). The median neck disability index during follow-up was 5, and median visual analog scale for pain was 2. Two professional athletes, 20 semiprofessionals, 24 hobby athletes, and 5 patients with a very low activity level were treated. The median time to resumption of sporting activity was 4 weeks after surgery. All professionals and semiprofessionals recovered to their previous activity level. All of the 20 hobby athletes recovered to resume their sport participation. The modified Tegner preoperative score was 4 and the postoperative score was 3.5 (P= 0.806). We found that cervical TDR did not prohibit sporting activities. All patients recovered and were able to take part in their previous activities at an appropriate intensity level.

311 Smith-Robinson Procedure With an Autologous Iliac Crest Bone Graft With and Without Caspar Plating as a Treatment for Soft Cervical Disc Herniation

311 Smith-Robinson Procedure With an Autologous Iliac Crest Bone Graft With and Without Caspar Plating as a Treatment for Soft Cervical Disc Herniation

Cervical disc hernia operations through posterior laminoforaminotomy

Objective:The most common used technique for posterolateral cervical disc herniations is anterior approach. However, posterior cervical laminotoforaminomy can provide excellent results in appropriately selected patients with foraminal stenosis in either soft disc prolapse or cervical spondylosis. The purpose of this study was to present the clinical outcomes following posterior laminoforaminotomy in patients with radiculopathy.Materials and Methods:We retrospectively evaluated 35 patients diagnosed with posterolateral cervical disc herniation and cervical spondylosis with foraminal stenosis causing radiculopathy operated by the posterior cervical keyhole laminoforaminotomy between the years 2010 and 2015.Results:The file records and the radiographic images of the 35 patients were assessed retrospectively. The mean age was 46.4 years (range: 34-66 years). Of the patients, 19 were males and 16 were females. In all of the patients, the neurologic deficit observed was radiculopathy. The posterolaterally localized disc herniations and the osteophytic structures were on the left side in 18 cases and on the right in 17 cases. In 10 of the patients, the disc level was at C5-6, in 18 at C6-7, in 2 at C3-4, in 2 at C4-5, in 1 at C7-T1, in 1 patient at both C5-6 and C6-7, and in 1 at both C4-5 and C5-6. In 14 of these 35 patients, both osteophytic structures and protruded disc herniation were present. Intervertebral foramen stenosis was present in all of the patients with osteophytes. Postoperatively, in 31 patients the complaints were relieved completely and four patients had complaints of neck pain and paresthesia radiating to the arm (the success of operation was 88.5%). On control examinations, there was no finding of instability or cervical kyphosis.Conclusion:Posterior cervical laminoforaminotomy is an alternative appropriate choice in both cervical soft disc herniations and cervical stenosis.

The Actual Level of Symptomatic Soft Disc Herniation in Patients with Cervical Disc Herniation.

ObjectiveThe aim of this study was to predict the relationship between the symptomatic disc herniation level and the osteophyte level or decreased disc height in patients with cervical disc herniation.MethodsBetween January 2011 and December 2012, 69 patients with an osteophyte of the cervical spine underwent surgery at a single center due to soft cervical disc herniation. Data including soft disc herniation level, osteophyte level in the posterior vertebral margin, Cobb's angle, and symptom duration were retrospectively assessed. The patients were divided into three groups according to the relationship between the degenerative change level and the level of reported symptoms.ResultsAmong the 69 patients, 48 (69.6%) showed a match between osteophyte level and soft disc herniation level. Disc herniation occurred at the adjacent segment to degenerative osteophyte level in 12 patients (17.4%) and at both the adjacent and the osteophyte level in nine (13.0%). There was no significant difference in Cobb's angle or duration among the three groups. Osteophyte type was not significant. The mean disc height of the prominent degenerative change level group was lower than the adjacent segment level, but this was not significant.ConclusionSoft cervical disc herniation usually occurs at the level an osteophyte forms. However, it may also occur at segments adjacent to that of the osteophyte level. Therefore, in patients with cervical disc herniation, although a prominent osteophyte alone may appear on plain radiography, we must suspect the presence of soft disc herniation at other levels.

Posterior decompression salvages Bryan total disc arthroplasty in post-operatively recurrent uncoforaminal stenosis

We report on 69 retrospectively reviewed patients who received 73 Bryan (Medtronic Sofamor Danek, Memphis, TN, USA) total disc arthroplasties for recent soft cervical disc herniations over a 9.3year period. Three patients returned with radiculopathy due to the redevelopment of uncoforaminal stenosis at the Bryan segment and later underwent posterior decompression of the uncoforaminal area without modification to the prosthesis. They recovered from the radiculopathy after decompression; however, one patient later required adjacent segment fusion to recover from concomitant cervicalgia. After posterior decompression, all prostheses continued to function normally. In one patient, however, bony bridging of the prosthesis is imminent, despite being currently asymptomatic. We normally exclude patients with uncoforaminal stenosis from Bryan arthroplasty. Analysis of three of these patients (4.3% of patients, 4.1% of prostheses) revealed that they received a prosthesis despite slight uncoforaminal stenosis (slight stenosis was known prior to surgery in one instance, two others were only discovered intra-operatively). Our observation raises the suspicion that slight uncoforaminal stenosis could also recur in physiologically working arthroplasty segments, and that in some instances this spur formation may progress into prosthesis bridging. However, more research is required to confirm the significance of uncoforaminal stenosis discovered pre- or intra-operatively in arthroplasty patients. Posterior minimally invasive decompression using the Frykholm–Scoville keyhole approach successfully treats uncoforaminal stenosis without revising the prosthesis.

Clinical application of anterior percutaneous endoscopic cervical discectomy

Objective To evaluate the safety,feasibility,and clinical outcome of anterior percutaneous endoscopic cervical discectomy (PECD).Methods The study involved 28 patients undergone PECD.Visual analogue scale (VAS) and MacNab scale were recorded before operation and at 3 days,1,3,6,12 and 18 months after operation.In addition,MRI examination was conducted at postoperative l month,3 months and 12 months.After data collection,single-factor T test with SAS software was performed.Results Follow-up (range,18-24 months,mean 19 months) was achieved in 25 patients.When compared to the preoperative score,VAS and MacNab scale presented improvement at postoperative 3 days (P ＞ 0.05) and great improvement at postoperative 1,3,6,12,18 and 24 months (P ＜ 0.01).VAS and MacNab scale at postoperative 3 days presented statistical differences as compared to those at postoperative 3,6,12 and 18 months (P ＜0.05),but the differences were not statistically insignificant at postoperative 3,6,12,and 18 months (P ＞ 0.05).Moreover,VAS and MacNab scale showed significant improvement at postoperative 24 months as compared to those before operation (P ＜0.01) and those at postoperative day 3 (P ＜ 0.01).Conclusion Anterior PECD is effective in treatment of cervical soft or partial hard disc herniation. Key words: Spinal injuries ; Cervical vertebrae ; Intervertebral disk ; Percutanous endoscopic cervical discectomy

Clinical features and surgical results of cervical myelopathy caused by soft disc herniation.

ObjectiveThere are many causes of cervical myelopathy including trauma, degenerative conditions, tumors and demyelinating disorders. However, myelopathy caused by soft disc herniation might be seen rarely than the spondylosis caused by hard disc. Here, authors retrospectively analyzed the clinical features and results of cervical myelopathy caused by soft disc herniation.MethodsFrom March 2010 to December 2010, 134 patients with degenerative cervical spinal disease were treated with anterior cervical discectomy and interbody fusion. Among them, 21 patients with cervical myelopathy secondary to cervical soft disc herniation were analyzed. Their clinical features, preoperative and, postoperative clinical results were evaluated by Nurick Grade and Japanese Orthopaedic Association scale (JOA) retrospectively. Preoperative clinical features including duration of myelopathy, pain intensity and postoperative clinical results including improvement rate of myelopathy and radiculopathy were retrospectively analyzed by Nurick Grade and JOA scale. We also evaluated correlation between the duration of symptom, type of the disc herniation, pain intensity and clinical outcome.ResultsMean age was 49.7 and male was predominant. Gait disturbance with mild to moderate pain was most common symptom in clinical features. Severe pain was shown in only 9 cases, and the other 12 cases experienced mild to moderate pain. Mean duration of myelopathy was 1.18 month. The mean JOA scores were 11.22 before surgery and 14.2 after surgery. The mean Nurick grades were 2.78 before treatment and 1.67 after treatment. Neurologic status of mild or moderate pain group on preoperative state is worse than that of severe pain group. The patients with duration of myelopathy symptom (<1 month) showed lower clinical improvement rate than the patients with myelopathy over 1 month. Patients with median type of disc herniation showed poorer neurological status than those with paramedian type of herniation in preoperative state.ConclusionAuthors reviewed the clinical features and surgical outcome of the cervical myelopathy secondary to cervical soft disc herniation. We presumed that patients of more than one month of symptom duration, mild to moderate initial symptom would be related with better postoperative improvement rate.

Influence of surgical treatment for disc degeneration disease at C5–C6 on changes in some biomechanical parameters of the cervical spine

A detailed three-dimensional solid model of the full cervical spine (C1–C7 levels) and the finite element analysis method were used to investigate the extent of changes in various biomechanical properties brought about when surgical methods are used to treat condition(s) caused by or are a sequela of disc degeneration disease at the C5–C6 level. The surgical methods simulated were anterior cervical discectomy and fusion, with interbody fusion achieved using a notional brick-shaped graft only; anterior cervical discectomy alone; percutaneous nucleotomy; and three variants of nucleus replacement. The control case was a model of an intact, healthy, adult spine. Each of these seven models was subjected to (1) flexion moment, extension moment, left lateral bending moment, right lateral bending moment, clockwise-acting axial rotation moment, and counterclockwise-acting axial rotation moment, with a compression pre-load applied simultaneously with each of these loadings and (2) an axial compression force (applied as a uniform pressure) only. For each combination of model and applied loading, the maximum von Mises stress and the maximum strain energy density were determined for tissues at the treated level, at one level above the treated level, and at one level below the treated level and (2) the total principal rotation angles at each of the intersegmental positions of the entire model. In addition, for each of the study cases, we obtained the longitudinal displacement of each of the models when subjected to the axial compression force only. We found markedly fewer changes (relative to the results when the intact, healthy spine model was used) in each of the above-mentioned biomechanical parameters above a specified threshold in the case of the simulated percutaneous nucleotomy and simulated nucleus replacement models, on one hand, compared to the simulated fusion and simulated discectomy models, on the other. This finding is in consonance with the evolving clinical practice of using minimally invasive surgical methods for treating problem(s) such as soft cervical disc herniations.

Computed Tomography Fluoroscopy-Guided Selective Nerve Root Block for Acute Cervical Disc Herniation

To analyze the clinical outcomes of computed tomography (CT) fluoroscopy-guided selective nerve root block (SNRB) for severe arm pain caused by acute cervical disc herniation. The authors analyzed the data obtained from 25 consecutive patients who underwent CT fluoroscopy-guided SNRB for severe arm pain, i.e., a visual analogue scale (VAS) score of 8 points or more, caused by acute soft cervical disc herniation. Patients with chronic arm pain, motor weakness, and/or hard disc herniation were excluded. The series comprised 19 men and 6 women whose mean age was 48.1 years (range 35-72 years). The mean symptom duration was 17.5 days (range 4-56 days) and the treated level was at C5-6 in 13 patients, C6-7 in 9, and both C5-6 and C6-7 in 3. Twenty-three patients underwent SNRB in 1 session and 2 underwent the procedure in 2 sessions. No complications related to the procedures occurred. At a mean follow-up duration of 11.5 months (range 6-22 months), the mean VAS score and NDI significantly improved from 9 and 58.2 to 3.4 and 28.1, respectively. Eighteen out of 25 patients (72%) showed successful clinical results. Seven patients (28%) did not improve after the procedure, and 5 of these 7 underwent subsequent anterior cervical discectomy and fusion. CT fluoroscopy-guided SNRB may play a role as a primary conservative treatment for severe arm pain caused by acute cervical disc herniation.

Percutaneous endoscopic cervical discectomy: 16 years of experience and literature review

The advancement of the percutaneous endoscopic lumbar discectomy (PECD) and its clinical success have led to similar minimally invasive approaches to the cervical spine. The goal of PECD is the decompression of the cervical nerve root through a direct endoscopic visualization, removing the herniated mass and shrinking the nucleous pulposus with the use of microforceps and holmium: yttrium-aluminum-garnet (Ho:YAG) laser. The senior author have performed PECD with cervical laser assisted endoscopy since 1993. The PECD is indicate to patients with constrained or unconstrained soft herniated cervical disc, positive provocative test, and no bony spur larger than 2 mm, regardless of the herniation size. The authors described the surgical technique of PECD and report their 16 years of experience in the endoscopic treatment of the herniated cervical disc.

Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy

The objective of this systematic review was to use evidence-based medicine to examine the efficacy of posterior laminoforaminotomy in the treatment of cervical radiculopathy. The National Library of Medicine and Cochrane Database were queried using MeSH headings and key words relevant to posterior laminoforaminotomy and cervical radiculopathy. Abstracts were reviewed, and studies meeting inclusion criteria were selected. The guidelines group assembled an evidentiary table summarizing the quality of evidence (Classes I-III). Disagreements regarding the level of evidence were resolved through an expert consensus conference. The group formulated recommendations which contained the degree of strength based on the Scottish Intercollegiate Guidelines network. Validation was done through peer review by the Joint Guidelines Committee of the American Association of Neurological Surgeons/Congress of Neurological Surgeons. Posterior laminoforaminotomy improves clinical outcome in the treatment of cervical radiculopathy resulting from soft lateral cervical disc displacement or cervical spondylosis with resulting narrowing of the lateral recess. All studies were Class III. The most frequent design flaw involved the lack of utilization of validated outcomes measures. In addition, few historical studies included a detailed preoperative analysis of the patients. As such, the vast majority of studies that included both pre- and postoperative assessments with legitimate outcomes measures have been performed since 1990. Posterior laminoforaminotomy is an effective treatment for cervical radiculopathy.

Effect of autologous platelet gel on early and late graft fusion in anterior cervical spine surgery

In a double-blind randomized study, platelet concentrate was used to treat 50 patients who underwent anterior cervical fusion with allograft bone and internal fixation, predominantly for degenerative disc disease or soft herniated cervical disc. The goal in this study was to compare the outcomes in patients treated with and without the platelet gel. Patients were assessed radiographically at 6, 12, and 52 weeks and at 2 years if needed. Clinically, patients were evaluated with the visual analog scale, Neck Disability Index, Short Form-36, and a modified Prolo Scale. Follow-up included 90% of the patients at 1 year and 84% at 2 years. The overall fusion rate was 84%. Whereas patients with degenerative discs treated with platelet gel demonstrated early fusion at the 12-week follow-up interval, no consistent early fusion was obtained with the use of the platelet gel preparation in patients with a soft disc herniation.