Percutaneous Endoscopic Cervical Discectomy Research Articles

Disc Height and Angle Changes on Radiographs and Magnetic Resonance Imaging after Anterior or Posterior Percutaneous Endoscopic Cervical Discectomy.

Objectives: Cervical disc herniation (CDH) leads to pain, numbness, and potential disability. Percutaneous endoscopic cervical discectomy (PECD) offers an anterior or posterior approach. This study aims to compare postoperative disc height and angle changes one year after PECD, considering both approaches. Methods: We retrospectively reviewed the data from patients with CDH who underwent PECD from October 2017 to July 2022. Cervical disc height was measured using the preoperative and one-year postoperative magnetic resonance imaging (MRI) examinations. Lordotic angle (LA), global alignment angle (GAA), segmental alignment angle (SAA), and slippage distance (SD) at the surgical level were measured on radiographs in the neutral, flexion, and extension positions. Results: Thirty-eight patients who underwent posterior PECD (PPECD) and five patients who underwent anterior PECD (APECD) were included in the evaluation. The mean age of the patients was 47.4 years (range: 29-69 years). There was a significant difference in the preoperative and one-year postoperative GAA and SAA in extension in the PPECD group (p = 0.003 and 0.031, respectively). The mean decreased disc height one-year postoperative was 1.30 mm in the APECD group and 0.3 mm in the PPECD group by MRI. A significant disc height decrease was observed in the APECD group (p < 0.001). Conclusions: Treating CDH with PPECD or APECD is feasible, as it can relieve symptoms and reduce disability. Stability remained unaffected during the first year after surgery, even though there was an increase in angulation during extension. Despite a significant decrease in disc space following APECD, patients reported significant symptom improvement and no new symptoms.

Anterior transcorporeal approach combined with posterior translaminar approach in percutaneous endoscopic cervical discectomy for two-segment cervical disc herniation treatment: a technical report and early follow-up

ObjectiveFull endoscopic techniques are being gradually introduced from single-segment cervical disc herniation surgery to two-segment cervical disc herniation surgery. However, there is no suitable full endoscopic treatment for mixed-type two-segment cervical disc herniation (MTCDH) in which one segment herniates in front of the spinal cord and the other segment herniates behind the spinal cord. Therefore, we introduce a new full endoscopic technique by combining an anterior transcorporeal approach and a posterior translaminar approach. In addition, we provide a brief description of its safety, efficacy, feasibility, and surgical points.MethodsThirty patients with MTCDH were given full endoscopic surgical treatment by a combined transcorporeal and transforaminal approach and were followed up for at least 12 months.ResultsClinical assessment scales showed that the patient’s symptoms and pain were significantly reduced postoperatively. Imaging results showed bony repair of the surgically induced bone defect and the cervical Cobb angle was increased. No serious complications occurred.ConclusionThis technique enables minimally invasive surgery to relieve the compression of the spinal cord by MTCDH. It avoids the fusion of the vertebral body for internal fixation, preserves the vertebral motion segments, avoids medical destruction of the cervical disc to the greatest extent possible, and expands the scope of adaptation of full endoscopic technology in cervical surgery.

Comparison of Outcomes between Unilateral Biportal Endoscopic and Percutaneous Posterior Endoscopic Cervical Keyhole Surgeries.

Objective: The purpose of this study was to compare the clinical and radiological outcomes of unilateral biportal endoscopic (UBE) and percutaneous posterior endoscopic cervical discectomy (PE) keyhole surgeries. Methods: Patients diagnosed with cervical spondylotic radiculopathy (CSR) treated by UBE or PE keyhole surgery from May 2017 to April 2020 were retrospectively analyzed. The length of incision, fluoroscopic time, postoperative hospital stay, and total cost were compared. The clinical efficacy was assessed using a visual analog scale (VAS), neck disability index (NDI), and modified MacNab criteria. Moreover, the C2-7 Cobb's angle, range of motion (ROM), intervertebral height, vertebral horizontal displacement, and angular displacement of the surgical segment were measured. Results: A total of 154 patients were enrolled, including 89 patients in the UBE group and 65 patients in the PE group, with a follow-up period of 24-32 months. Compared with PE surgery, UBE surgery required shorter fluoroscopic times (6.76 ± 1.09 vs. 8.31 ± 1.10 s) and operation times (77.48 ± 17.37 vs. 84.92 ± 21.97 min) but led to higher total hospitalization costs and longer incisions. No significant differences were observed in the postoperative hospital stay, bleeding volume, VAS score, NDI score, effective rate, or complication rate between the UBE and PE groups. Both the C2-7 Cobb's angle and ROM increased significantly after surgery, with no significant differences between groups. There were no significant differences between intervertebral height, vertebral horizontal displacement, and angular displacement of the surgical segment at different times. Conclusions: Both UBE and PE surgeries in the treatment of CSR were effective and similar after 24 months. The fluoroscopic and operation times of UBE were shorter than those of PE.

Global Trends and Hotspots in Endoscopic Discectomy: A Study Based on Bibliometric Analysis.

With the advancement of minimally invasive spine surgery, endoscopic discectomy (ED) has become a common technique for degenerative disease of the spine. The present study aimed to explore the knowledge structure, emerging trends, and future research hotspots in this field. All relevant publications on ED from 2002 to 2021 were extracted from the Web of Science databases. Key bibliometric indicators, including countries/regions, institutions, authors, journals, references, and keywords were calculated and evaluated using VOSviewer and CiteSpace software. A total of 1,196 articles and reviews were included for analysis. The number of publications regarding ED increased yearly. From the quality and quantity viewpoint, China, South Korea, and the United States were the major contributors in this field. The most influential institution in the field of ED was Wooridul Spine Hospital. We identified 3,488 authors, among which Lee SH had the most significant number of papers, and Ruetten S was cocited most often. <World Neurosurgery was the journal with the most papers, and Spine was the most commonly cocited journal. Keywords were stratified into 4 clusters by VOSviewer software: cluster 1 (clinical outcomes of ED in the treatment of lumbar disc herniation); cluster 2 (surgical technique of percutaneous endoscopic lumbar discectomy); cluster 3 (clinical outcomes of ED in the treatment of lumbar spinal stenosis); and cluster 4 (clinical outcomes of percutaneous endoscopic cervical discectomy). Several topics including lateral recess stenosis, spinal stenosis, and reoperation were considered as the next hotspot in ED research. ED research has gained considerable attention over the last 2 decades. Our bibliometric findings illuminate the publication trends and research hotspots of the ED field, which may provide useful references for scholars and decision-makers interested in this field.

Percutaneous endoscopic cervical discectomy with lamina-hole approach in treatment of cervical radiculopathy: an analysis of short-term clinical outcomes

Percutaneous endoscopic cervical discectomy with lamina-hole approach in treatment of cervical radiculopathy: an analysis of short-term clinical outcomes

Application of Triggered EMG in the Intraoperative Neurophysiological Monitoring of Posterior Percutaneous Endoscopic Cervical Discectomy.

ObjectiveTo describe the rationale and application of triggered EMG (T‐EMG) in intraoperative neurophysiological monitoring, and to explore the efficacy and safety of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy (CSR) under multimodal intraoperative neurophysiological monitoring (IOM).MethodsThis study was a retrospective cohort control study. The clinical data of 74 patients with single‐segment CSR from June 2015 to August 2018 were analyzed retrospectively, of whom 35 underwent IOM‐assisted PPECD with triggered EMG (T‐EMG group), while 39 were subjected to IOM‐assisted PPECD alone (IOM group). Operation time, hospital stay, and complications were recorded for both groups. The curative effect was evaluated according to the Visual Analog Scale (VAS) of neck and arm pain, Japanese Orthopaedic Association (JOA) score, and modified MacNab scale.ResultsOperations were successful and all patients were followed up for at least 24 (average 31.77 ± 9.51) months with no patient lost to follow‐up. No significant difference was found in preoperative baseline data between the T‐EMG and the IOM group (P > 0.05). Also, no significant difference was found in the operation time between the T‐EMG (108.29 ± 11.44 min) and the IOM (110.13 ± 12.70 min) (P > 0.05) group, but the difference in hospital stay (T‐EMG: 5.66 ± 0.99 days; IOM: 7.10 ± 1.43 days) was statistically significant (P < 0.05). The VAS for the neck and upper limbs in the two groups at 1 month post‐operation (T‐EMG: 2.09 ± 1.07, 2.26 ± 0.92; IOM:2.18 ± 1.05, 2.31 ± 0.77) and the last follow‐up (T‐EMG: 0.83 ± 0.62, 0.86 ± 0.55; IOM: 0.90 ± 0.50, 0.87 ± 0.61) were significantly different from the preoperative scores (T‐EMG: 6.14 ± 1.09, 7.17 ± 1.04; IOM: 6.18 ± 1.28, 7.15 ± 1.23) (P < 0.05). However, no significant difference was found between the two groups (P > 0.05). The 1‐month postoperative JOA scores for the two groups (12.69 ± 0.76; 12.59 ± 0.82) and those at the last follow‐up (14.60 ± 0.77; 14.36 ± 0.78) were significantly different from the preoperative scores (11.09 ± 0.98; 11.05 ± 0.89) (P < 0.05), but the difference between the two groups was not significant (P > 0.05). One patient in the T‐EMG group developed a transient aggravation of symptoms on the first day after surgery. In the IOM group, three patients had intraoperative cerebrospinal fluid leakage, and symptoms of C5 nerve root paralysis were presented in four patients following surgery. Compared with the IOM group, the T‐EMG group had fewer complications (1/35; 7/39, P < 0.05). At the last follow‐up, the modified MacNab criteria were 91.43% (32/35) and 89.7% (35/39) for the T‐EMG group and IOM group, respectively.ConclusionsTriggered EMG prevents the occurrence of neurological complications, which not only aids PPECD for CSR treatment in achieving satisfactory results, but also reduces average hospital stay and complication rates.

Clinical Outcomes of Posterior Percutaneous Endoscopic Cervical Foraminotomy and Discectomy Assisted with SNRB in Treating Cervical Radiculopathy with Diagnostic Uncertainty

Selective nerve root block (SNRB) has been used to facilitate the diagnostic process when radiologic abnormalities are not correlated with clinical symptomatology in patients with cervical radiculopathy. Meanwhile, minimally invasive posterior percutaneous endoscopic cervical foraminotomy and discectomy (PPECFD) has been widely used to treat cervical radiculopathy because of its advantages. However, combination of these 2 procedures in the treatment of cervical radiculopathy with diagnostic uncertainty has not been reported. To examine the clinical outcomes of PPECFD assisted with SNRB in patients who had cervical radiculopathy with diagnostic uncertainty. A retrospective design was used. This study was conducted in a university-affiliated tertiary hospital in Shanghai, China. Thirty consecutive patients with cervical radicular pain who had diagnostic uncertainty were included (January 2018 to January 2019). Diagnostic SNRB was performed to identify the responsible nerve root(s). PPECFD was selected as the treatment when the SNRB result was positive. Clinical outcomes were assessed by the Visual Analog Scale (VAS), Neck Disability Index (NDI), and modified Macnab criteria. Pre- and post-operative radiologic and clinical parameters were evaluated. Other information was retrieved from the electronic records. All patients had successful SNRB procedures. Four were excluded from the analysis because of the negative results of the SNRB. Among the remaining 26 patients who underwent the subsequent PPECFD surgery, the mean follow-up was 14 months. Compared with preoperative values, the mean VAS scores for radicular arm pain and neck pain, as well as the NDI score, improved significantly. According to the Macnab criteria, 22 patients (84.6%) had excellent or good results. No major peri- and postoperative complications were observed. This study used a retrospective design with relatively small sample size and medium follow-up duration. Diagnostic SNRB may be a helpful tool to identify the origin of cervical radicular pain for patients with diagnostic uncertainty. With the guidance of SNRB, PPECFD is likely to be an effective and safe option for the treatment of cervical radiculopathy with diagnostic uncertainty.

Clinical study on the efficacy and safety of percutaneous endoscopic anterior cervical discectomy in the treatment of cervical disc herniation.

To compare the clinical efficacy of anterior percutaneous endoscopic cervical discectomy (APECD) and anterior cervical decompression and fusion (ACDF) in the treatment of cervical disc herniation. A total of 115 cases of cervical disc herniation treated in our hospital from May 2016 to August 2018 were selected. The subjects were divided into APECD and ACDF groups. The operation time, intra-operative blood loss, and hospital stay of the two groups were recorded and compared, and the clinical symptoms were recorded at one week, one year, and two years after the operation. The neck and upper limb visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, cervical range of motion (ROM), post-operative cervical lordosis angle and adjacent vertebral body height were compared between the two groups. All 115 patients underwent successful operations. The intra-operative blood loss and operation time in the APECD group were significantly less than those in the ACDF group (P < 0.05). There were no oesophago-tracheal sheaths, carotid artery sheaths, cervical sympathetic trunks, vertebral artery injuries, or dural tears in the two groups. The JOA and VAS scores of the two groups significantly improved from pre- to post-operatively, but there were no significant differences between the two groups at the last follow-up (P > 0.05). The post-operative radiological results showed that the herniated cervical intervertebral disc was removed completely. One year after the operation, the cervical lordosis angle increased significantly in both groups (P < 0.05). However, ROM decreased significantly in the ACDF group (P < 0.05), and there was no significant change in ROM in the APECD group (P > 0.05). The cervical lordosis angle did not significantly differ between the two groups at the last follow-up (P > 0.05), but there was a significant difference in ROM between the two groups at the last follow-up (P < 0.05). In the ACDF group, the height of the adjacent vertebral body increased 1 year after the operation (P < 0.05). In the APECD group, the height of the adjacent vertebral body decreased one year after the operation, but the value was not significantly different from the pre-operative value (P > 0.05). There was a significant difference in the height of the adjacent vertebral body between the two groups at the last follow-up (P < 0.05). The incidence of post-operative complications did not significantly differ between the two groups (P > 0.05). APECD is a minimally invasive treatment that is safe and effective. The medium- and short-term effects of APECD and ACDF in the treatment of cervical disc herniation are similar. In addition, APECD is superior to ACDF in the operation time, intra-operative blood loss, and ROM. However, prospective, multicenter studies with longer follow-up periods need to be conducted, and the recurrence rate and intervertebral height loss need to be studied.

Clinical efficacy of posterior percutaneous endoscopic cervical discectomy for single level cervical spondylopathy with intraspinal ossification

To evaluate the effectiveness and security of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of single level cervical spondylopathy with intraspinal ossification. Twenty three patients with single level cervical spondylopathy with intraspinal ossification were treated by posterior percutaneous endoscopic cervical discectomy between August 2017 and July 2019. There were 16 males and 7 females, aged from 29 to 74 years old with an average of (50±13) years.The disease duration were 3 to 120 months with a median of 6 months. There were 9 cases of cervical spondylotic radiculopathy, 6 cases of cervical spondylotic myelopathy, and 8 cases of mixed cervical spondylopathy. According to the characteristics of ossification, 17 cases were osteophytes on the posterior edge of the vertebral body;3 cases were protrusion ossification;3 cases were posterior longitudinal ligament ossification. According to the position of ossification in spinal canal, 14 cases were medial and lateral type, 5 cases were central type, and 4 cases were mixed type. Posterior percutaneous cervical endoscopic cervical discectomy in patients performed by the same surgeon. Japanese Orthopaedic Association (JOA) score and visual analogue scale(VAS) were compared separately before and after operation. At 3 months after operation, clinical effect was assessed according to modified Macnab standard. All operations were successful. The operative time was 30 to 155 (69.1±27.2) min. The bedridden time was 2 to 3(3.0±0.9) h, length of postoperative hospitalization was 2 to 7(4.1± 1.5) d. Three dimensional CT reconstruction of the cervical spine at 3 days after operation showed that ossified tissue of 13 cases were completely removed, and 10 cases were left after operation, and the residual was located at the posterior edge and/or center of the upper vertebral body. VAS score at discharge from hospital was significantly lower than that before operation (t=9.35, P<0.001), and 21 cases had a score of 0 to 3. Postoperative JOA score was significantly higher (t=7.29, P<0.001). At 3 months after operation, according to modified Macnab standard to evaluate clinical effect, 18 cases got exellent results, 4 good and 1 fair, with an excellent and good rate of 95.6%(22/23). For an experienced surgeon, percutaneous posterior cervical endoscopic discectomy is safe and reliable in treating single level cervical spondylopathy with intraspinal ossification, and can obtain good clinical results.

Treatment of Cervical Spondylotic Radiculopathy with Posterior Percutaneous Endoscopic Cervical Discectomy

Purpose Objective to investigate the safety and clinical efficacy of posterior percutaneous endoscopic discectomy (PPECD) in the treatment of cervical spondylotic radiculopathy (CSR). Method from January 2016 to December 2019, 35 cases of CSR were treated with PPECD. The degree of pain was evaluated by numeric rating scales (NRS) before operation, at discharge, 1 month, 3 months, 6 months, 1 year after operation and at the last follow-up. The functional recovery was evaluated by neck disability index (NDI) and Japanese orthopaedic association (JOA). The clinical efficacy was evaluated by modified MacNab grading and MRI at the last follow-up. Result of the 35 patients, 16 males and 19 females were aged 39~78 years, with an average age of (54.0 ± 9.9) years. The operative segments were C4-5 9, C5-6 15 and C6-7 11. All 35 patients successfully completed the operation. The operation time was 60~90min, the average time was (75.0 ± 7.9) min, the bleeding volume was 10~22ml, the average (16.3 ± 3.1) ml, the postoperative hospitalization days were 4~12 days, and the average was (7.0 ± 1.6) days. All 35 patients were followed up for more than one year after operation, with an average follow-up of 26.7 months (13~53 months). The NRS index was significantly lower in each period than before operation (P < 0.01), NDI and JOA index were significantly lower than those before operation (P < 0.01). The clinical effect was evaluated at the last follow-up, 20 cases were excellent, 12 were good, 3 were fine, and the excellent rate was 91.4%. No complications such as nerve root injury, dural sac tear or infection occurred during the follow-up period, and no patients needed to receive secondary minimally invasive or open surgery for symptom recurrence. Conclusion Under the premise of strictly grasping the indications, the curative effect of PPECD in the treatment of CSR is confirmed, and the patients' satisfaction is high.

Parametric study of anterior percutaneous endoscopic cervical discectomy (APECD)

Anterior percutaneous endoscopic cervical discectomy (APECD) is a common treatment for cervical spondylotic radiculopathy (CSR). In this study, the effects of various channel diameters and approach angles on cervical vertebrae on postoperative outcomes in APECD surgery were explored. A finite element model of intact cervical C3-C7 was constructed and then modified to obtain six surgical models. Range of motion (ROM) and intradiscal pressure (IDP) were calculated under different conditions of flexion (Fle), extension (Ext), lateral bending, and axial rotation. During Fle and bending to the left (LB), the ROM was closer to the intact model when the angle of approach was 90°. During bending to the left (LB) and rotation to the left (LR), the ROM changed considerably (43.2%, 33.7%, respectively) where the angle of approach was 45°. As the surgical channel diameter increased, the extent of the change in ROM compared with the intact model also increased. IDP decreased by 48% and 49%, respectively, compared with the intact model at the C5-C6 segment where the angle of approach was 45° and 60° during Fle, while it changed little at 90°, by less than 10%. The IDP was increased noticeably by 117.6%, 82.1%, and 105.8%, for channel diameters of 2, 3 and 4 mm, respectively. And declined noticeably during LB and LR (LB: 27.1%, 27.1%, 38.5%; LR: 37.4%, 35.5%, 48.7%). The results demonstrated that the shorter the surgical path, the smaller surgical diameter, the less the biomechanical influence on the cervical vertebra.

Posterior Percutaneous Transpedicular Endoscopic Approach for Treating Single-Segment Cervical Myelopathy.

Background Standard posterior percutaneous endoscopic cervical discectomy (PECD) is considered an effective minimally invasive surgery. Although standard PECD can be used to treat radiculopathy with relatively minimal trauma, it is still a challenge to use this approach for treating myelopathy. Objective This report is aimed at first describing a posterior transpedicular approach under endoscopy for myelopathy and evaluating the feasibility and short-term clinical effects of this approach. Methods In our retrospective analysis between Feb. 2016 to Mar. 2017, 16 patients managed with PECD using the posterior transpedicular approach for symptomatic single-segment myelopathy. Surgery involved drilling 1/2 to 2/3 of the medial portion of the pedicle under endoscopy to provide sufficient space and an appropriate angle for inserting the endoscope into the spinal canal, followed by ventral decompression of the spinal cord. Computed tomography and magnetic resonance imaging were used to evaluate pedicle healing and spinal cord decompression. The primary outcomes included a visual analog scale (VAS) scores of axial neck pain and Japanese Orthopaedic Association (JOA) scores of neurological conditions. Results All patients completed a 1-year follow-up examination. The mean duration of surgery was 95.44 ± 19.44 min (52–130 min). The fluoroscopy duration was 5.88 ± 1.05 (4–7). The VAS scores of axial pain significantly improved from 6.94 ± 0.75 preoperatively to 2.88 ± 1.22 postoperatively (P < 0.05). The mean JOA scores improved from 8.50 ± 1.12 preoperatively to 14.50 ± 1.46 at the final follow-up (P < 0.05). The effects were excellent in 8 cases, good in 6 cases, and fair in 2 cases. After partial pedicle excision, the width of the remaining pedicle was 1.70 ± 0.22 mm postoperatively and significantly recovered to 3.38 ± 0.49 mm at the 1-year follow-up. There were no surgery-related complications, such as dural tearing, spinal cord injury, nerve root injury, pedicle fracture, and cervical hematocele or infection. Conclusions The posterior transpedicular approach is an effective method for the treatment of myelopathy in select patients and is a supplement to the described surgical approach for PECD.

Early efficacy of percutaneous endoscopic cervical discectomy with multimodal neurophysiological monitoring

Objective: To explore the clinical efficacy of percutaneous endoscopic cervical discectomy (PECD) assisted by neurophysiology monitoring (NM) in the treatment of cervical spondylotic radiculopathy (CSR). Methods: The clinical data of 55 patients with CSR treated in the Department of Spinal Surgery of Henan Provincial People's Hospital from April 2015 to May 2018 were analyzed retrospectively. Among them, 29 patients were treated with multi-mode NM-assisted PECD (NM group) and 26 patients with PECD alone (PECD group). The gender, age, operation time, bleeding volume, average hospital stay and complications between the two groups were recorded and compared. In addition, the visual analogue score (VAS) of neck and upper limb pain and the score of Japanese Orthopedic Association (JOA) were compared between the two groups before operation, 1 month after the operation and at the last follow-up. These data between groups were compared by independent sample t test. Results: All patients in both groups were followed-up for at least 18 months. Neck VAS and upper limb VAS scores of two groups at 1 month post operation (neck: 2.1±1.2, 2.0±1.1; upper lamb: 2.4±1.2, 2.2±0.8) and the last follow-up (neck:0.8±0.5, 0.7±0.5; upper lamb: 0.8±0.7, 0.8±0.5) decreased significantly when compared with those before the operation (neck: 6.0±1.0, 5.9±1.0; upper lamb: 7.1±0.9, 7.4±0.9) (t=12.670-27.305, all P<0.05). However, there was no significant difference between the two groups (t=-1.107-0.917, all P>0.05). JOA scores of two groups at 1 month after the operation (12.7±0.8, 12.6±0.8), and at the last follow-up (14.6±0.7, 14.4±0.8) were all improved significantly from those before the operation (11.1±1.0, 10.9±0.8) (t=-11.074, -14.829, -9.603, -13.086, all P<0.05); however, there was no significant difference between the two groups (t=0.842, 0.003, both P>0.05). There was also no significant difference in bleeding volume, and operation time between the two groups, (t=-0.615, -0.922, P>0.05) but the average hospital stay and incidence of complications in the NM group were significantly lower than those in the PECD group (t=-2.815, χ(2)=4.755, both P<0.05). Conclusion: Multimode NM-assisted PECD in the treatment of CSR achieves satisfactory results, reducing the average hospital stay, reducing complications and improving surgical safety.

Trans-interlamina percutaneous endoscopic cervical discectomy for symptomatic cervical spondylotic radiculopathy using the new Delta system

To describe the rationale and surgical technique and compare the clinical effect of posterior percutaneous endoscopic cervical discectomy (PPECD) using the Delta system versus that of conventional PPECD (key-hole) surgery for the treatment of symptomatic cervical spondylotic radiculopathy (CSR). A retrospective analysis was performed on 106 single-segment CSR patients between February 2016 and February 2017, 50 of whom underwent conventional PPECD (key-hole), and 56 underwent PPECD using the Delta system. The operative time, intraoperative blood loss, intraoperative complications and postoperative hospital stay were recorded, and the clinical effect was evaluated by the indicators of the Neck Disability Index (NDI), arm-visual analog scale (arm-VAS), neck-VAS, EQ-5D and MacNab classification at the last follow-up. All patients underwent the operation successfully, and 106 patients were followed up. The operative time of the Delta group was 60.47 ± 0.71 min, while the operative time of the key-hole group was 75.46 ± 0.41 min. The difference between the two groups was statistically significant (P < 0.05). However, there was no significant difference between the two groups in terms of blood loss and hospital stay (P > 0.05). The VAS, NDI and EQ-5D scores of the neck and upper limbs in the two groups were significantly better than those before surgery at 1 week after surgery and at the last follow-up (P < 0.05). However, there was no significant difference between the two groups at the last follow-up (P > 0.05). At the last follow-up, there was no significant difference between the two surgical methods when evaluated using the modified MacNab criteria. The imaging results showed that the herniated disc was removed completely and the nerve root was decompressed. The complication rate in the Delta group (3/56, 5.35%) was significantly lower than that in the conventional key-hole group (5/50, 10.0%). PPECD using the Delta system for CSR may be a feasible and promising alternative surgical plan. Compared with the traditional key-hole method, this surgical system can not only provide the surgeon with a larger surgical field of vision but also reduces the operation time and complication rates.

Treatment of cervical spondylotic radiculopathy with posterior percutaneous endoscopic cervical discectomy: Short-term outcomes of 24 cases.

To determine the short-term clinical outcomes of single-segment cervical spondylotic radiculopathy treated with posterior percutaneous endoscopic cervical discectomy (PPECD).Data of a total of 24 patients who underwent PPECD and local anesthesia for single-level segmental cervical spondylotic radiculopathy between March 2016 and December 2017 were reviewed. The Japanese Orthopaedic Association, visual analog scale (VAS), and neck disability index scores at preoperative 1 day, postoperative 1 day, 1 week, 1 month, 3 months, 6 months, and 1 year were recorded. The modified MacNab criteria at the last follow-up were re-recorded for the evaluation of clinical effectiveness.All operations were successfully completed under endoscopic guidance. No patient showed spinal cord, nerve root, vascular injuries, dural tears or other complications. The postoperative VAS scores of the arm and neck were significantly reduced compared with the preoperative VAS scores (P < .05), while postoperative the Japanese Orthopaedic Association scores were significantly increased (P < .05). The postoperative neck disability index scores were significantly reduced compared with preoperative scores (P < .05). The modified MacNab criteria at the last follow-up showed 16 excellent cases, 8 good cases, 0 fine cases, and 0 poor cases. Postoperative magnetic resonance imaging and cervical 3-dimensional computed tomography reconstruction showed that the intervertebral disc was adequately resected and the nerve root was not under compression.PPECD is safe and effective for the treatment of single-segment cervical spondylotic radiculopathy.

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.

Posterior percutaneous endoscopic cervical foraminotomy and discectomy for degenerative cervical radiculopathy using intraoperative O-arm imaging.

IntroductionPosterior percutaneous endoscopic cervical foraminotomy and discectomy (P-PECD) is a minimally invasive technique for the treatment of degenerative cervical radiculopathy. The O-arm, an intraoperative mobile computed tomography (CT) scanner, may improve spine surgery outcomes.AimTo evaluate clinical outcomes of O-arm assisted P-PECD in patients with degenerative cervical radiculopathy.Material and methodsBetween January 2013 and January 2018, 32 patients with degenerative cervical radiculopathy who underwent P-PECD were followed up for 12 months. Their demographic, clinical and surgical data were reviewed retrospectively. All patients received intraoperative O-arm scanning to assess working cannula placement and decompression. The visual analogue scale (VAS), the neck disability index (NDI), and Odom’s criteria were used to evaluate clinical outcomes.ResultsCompared with preoperative values, mean NDI, neck-VAS, and arm-VAS scores were dramatically improved 1 week postoperatively, and the improvement was maintained for at least a year after surgery (from 27.6 ±10.5, 5.8 ±1.7, and 7.2 ±2.3 to 1.4 ±0.8, 1.1 ±0.8 and 0.9 ±0.6, respectively). According to Odom’s criteria, 27/32 patients (84.4%) reported excellent or good results. There were no permanent complications. One patient suffered from transient thumb weakness due to a cervical nerve root injury caused by the spinal needle.ConclusionsP-PECD aided by intraoperative O-arm imaging is a safe, effective, and minimally invasive procedure for treating degenerative cervical radiculopathy that can provide accurate cannula placement and thorough decompression.

Modified K-Hole Percutaneous Endoscopic Surgery for Cervical Foraminal Stenosis: Partial Pediculectomy Approach

Background: Percutaneous endoscopic cervical discectomy has evolved as an efficient, minimally invasive spine surgery for radiculopathy caused by soft and/or osseous foraminal stenosis. Although interlaminar access can be used to resect lateral herniated lesions or osteophytes located in the foramina, with limited operative space, nerve retraction may be unavoidable. This procedure may injure the nerve root and cause postoperative arm pain, numbness, and muscle weakness, especially when the herniation is located in the ventral nerve root or when there is a massive osteophyte in the foramina. However, posterior partial cervical pediculectomy under endoscopy provides a new approach to effectively reduce or even avoid nerve retraction and reduce the potential risk of nerve injury. Objectives: This report presents a partial pediculectomy approach and compares the clinical outcomes of different surgical methods, including posterior percutaneous endoscopic cervical discectomy (P-PECD) and P-PECD combined with partial pediculectomy Study Design: This study used a retrospective comparative study design. Setting: This study took place at the Second Affiliated Hospital of Chongqing Medical University. Methods: From February 2015 to March 2017, 84 patients with single-level and unilateral soft and/or osseous cervical foraminal stenosis were recruited. Patients were treated with P-PECD (40 patients) and P-PECD combined with partial pediculectomy (44 patients). Postoperative clinical outcomes were assessed using the modified MacNab grading criteria and the Visual Analog Scale (VAS) at different times after surgery. The surgery duration, dosage of postoperative analgesic medication, duration of hospital stay, and postoperative complications were recorded. Results: The mean duration of the conventional P-PECD surgery was 74.48 ± 7.08 minutes, which was significantly longer (P = 0.002) than that observed for the P-PECD with partial pediculectomy (66.00 ± 9.62 minutes). The analgesic dosage in the conventional P-PECD group was significantly higher than that in the partial pediculectomy group (9.14 ± 3.07 units vs. 5.71 ± 3.41 units; P = 0.001). The hospital stay in the conventional P-PECD group was significantly longer than that in the partial pediculectomy group (3.86 ± 0.85 days vs. 3.24 ± 0.83 days; P = 0.022). The VAS scores at 1 day, 3 days, and 7 days after surgery in the conventional P-PECD group were significantly higher than those in the partial pediculectomy group (all P &lt; 0.001). The modified MacNab grading criteria showed no significant difference at each follow-up (P = 1). The incidence of complications in the P-PECD with partial pediculectomy group (2/44, 4.55%) was significantly lower than that in the conventional P-PECD group (4/40, 10.0%), including complications of increased pain, increased numbness, and worsening of muscle weakness. Limitations: This study is limited by being a retrospective study, and by having a small sample size and a short follow-up period. Conclusions: As an alternative to the P-PECD surgical technique, P-PECD with partial pediculectomy effectively reduced the postoperative complications and may be preferable when considering the surgery duration, postoperative hospital stay, analgesic dosage, and postoperative VAS score. Key words: Cervical disc herniation, foraminal stenosis, percutaneous endoscopic cervical discectomy, PECD, P-PECD, partial pediculectomy

Feasibility of percutaneous posterior endoscopic cervical discectomy puncture with magnetic navigation ultrasonography system guidance

Objective To evaluate the feasibility of magnetic navigation ultrasonography system in guiding the puncture of percutaneous posterior endoscopic cervical discectomy(PPECD). Methods The cervical CT data of 6 patients with cervical spondylosis were used to made 3D printing model, then the localized puncture of the model was guided by the magnetic navigation ultrasonography system, 1-mm-slice transection CT scans were obtained to confirm the placement of the needle tips after puncture. The total puncture time and the distance between the pinpoint in the lateral and longitudinal directions from the V point were recorded. Results All the 36 puncture operations accurately located the target segment without penetrating the spinal canal. The average lateral distance of the needle tip from the V point was 2.88 mm(0-7.12 mm), meanwhile the average longitudinal distance was 1.64 mm(0-4.45 mm), and the the whole process took 3.72 min(2.42-5.20 min). Thirty-three of 36 points were in the circle with V point as the center and 5mm as the radius, puncture success rate was 91%. Conclusions The puncture model established in this study can be used as a teaching tool, magnetic navigation ultrasonography system has successfully guided the posterior cervical intervertebral disc puncture on the model, and there is no radiation exposure during the operation process, which has a promising clinical application prospect. Key words: Magnetic navigation ultrasonography system; 3D printing; Cervical vertebrae

Biomechanical comparison of percutaneous posterior endoscopic cervical discectomy and anterior cervical decompression and fusion on the treatment of cervical spondylotic radiculopathy

BackgroundCervical spondylotic radiculopathy is a common spinal disease. The traditional surgical treatment consists of anterior cervical decompression and fusion (ACDF), but it presents problems such as trauma and fusion complications. Percutaneous posterior endoscopic cervical discectomy (PPECD) is a new minimally invasive technology that has produced good clinical outcome, but further biomechanical comparisons are needed to guide the clinical work. The goal of this study was to compare the biomechanical characteristics of the two methods by finite element analysis.MethodOn the basis of the computed tomography scanning data of five cases of cervical spondylosis after PPECD surgery, five cases after ACDF surgery, and five non-surgical patients, software (Mimics 15.0, HyperMesh 12.0, and Abaqus 6.13) was adopted to establish a C1–C7 segment 3D finite element model. We also applied 50 N vertical load on the C1 surface and 1.5 Nm torque, simulated the anteflexion, rear protraction, and left and right lateral flexion and rotation, and observed the stability, stress distribution, and Cobb angular change of the surgical section of the cervical vertebra under different working conditions.ResultThe postoperative model under different working conditions demonstrated poorer stability than the non-surgical group, but the stability of the PPECD group was close to that of the non-surgical group. The stability of the ACDF group was the worst, especially when making lateral bending and posterior extension. The ACDF group also showed significant differences. The PPECD group showed uniform stress distribution, whereas the ACDF group was under large stress, which was primarily concentrated in the internal fixation system. In addition, the implant showed the potential for fracture. The Cobb angle of surgery section of the PPECD group was smaller than that of the ACDF group, and the stability of the section was good.ConclusionFrom the perspective of finite element analysis, the cervical vertebrae after PPECD treatment showed good biomechanical performance and stability.