Factors predicting excellent outcome of percutaneous cervical discectomy: analysis of 111 consecutive cases

Abstract

Percutaneous cervical discectomy (PCD) has been developed as an effective treatment option for soft cervical disc herniation. However, no prognostic study of this procedure has yet been made. The purpose of this study was to evaluate the surgical outcome of PCD and to determine the factors predicting excellent outcome. A retrospective review was performed of 111 consecutive patients who underwent PCD with a mean follow-up period of 49.4 months (range, 29-64 months). Under local anesthesia, a percutaneous anterior approach was followed by discectomy with microforceps and endoscopic Ho:YAG laser. The surgical outcomes of the 111 patients based on the Macnab criteria were excellent in 52 patients (46.9%), good in 37 (33.3%), fair in 9 (8.1%), and poor in 13 (11.7%), thereby indicating a symptomatic improvement in 88.3% of the patients. In this study, the two major factors predicting an excellent long-term outcome were the symptom of radiating arm pain (P = 0.02) and the location of lateral disc herniation (P < 0.02). Proper patient selection remains critical for the success of this minimally invasive procedure.

Conventional versus minimally-invasive cervical discectomy for treatment of severe degenerative disease at C5-C6: a biomechanical comparison using a model of the full cervical spine and finite element analysis

“…There are two variants of cervical discectomy that are in clinical use; namely, the standard or open method and the minimally-invasive or percutaneous method [1,[3][4][5][6][7][8][9]. There are no biomechanical comparisons of these two variants.…”

“…Although both conventional and minimally-invasive techniques for cervical discectomy have been shown to be safe, efficacious, and with low rates of postoperative surgical site infections [1,3,[5][6][7][8]34], to the best of our knowledge, there are no literature reports (case studies, prospective data from surgical registries, or prospective, randomized, controlled trials) on comparison of these two variants on the basis of, for example, duration of surgery and clinical outcomes. This situation contrasts with that for lumbar discectomy, in which there are comparisons of conventional and minimally-invasive techniques on the basis of, for example, length of operating time, blood loss, duration of hospital stay, surgical complications, and outcome measures (such as changes in Visual Analogue Scale, Oswestry Disability Index, and the Core Outcome Measures Index after the surgery) and duration of hospital stay [35][36][37]), These comparisons found no significant difference in, for example, rate of surgical complications, duration of hospital stay, and any outcome measures between the two variants [35][36][37].…”

“…Minimally-invasive discectomy was simulated by using aspects of the technique described by Chiu et al [5] and by Ahn et al [6]. This meant shaving all around the periphery of the AF, such that the final volume of the AF was 85% of that in INT model, and reducing the volume of the NP to be 17% of that in INT model.…”

“…These are anterior cervical discectomy followed by fusion (ACDF) (the most popular method) [1,2]; discectomy without fusion (DISWF) (used in a modest number of cases) [1,[3][4][5][6][7][8][9]; percutaneous nucleotomy (used in a few cases) [10]; total disc replacement (recently approved by regulatory bodies, such as the US Food and Drug Administration) [11][12][13]; and nucleus pulposus (NP) replacement [14] and intervertebral disc transplant [15] (each being an emerging option).…”

“…One is referred to as the conventional, standard, or open approach [1,3,4] while the other is a family of minimally-invasive procedures, namely, percutaneous cervical discectomy, percutaneous endoscopic cervical discectomy, percutaneous cervical laser decompression, percutaneous microcompressive endoscopic cervical discectomy microdiscectomy [5][6][7][8][9]. Arguably, the two most important driving forces for the introduction and increasing popularity of the latter techniques are to utilize a narrower surgical entry window and to reduce the amount of soft tissue that is disrupted and/or excisedin addition to the affected parts of the disccompared to the former procedure [16].…”