Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations

Abstract

Anterior cervical decompression and fusion (ACDF) is the standard for cervical discectomies. With the full-endoscopic anterior cervical discectomy (FACD) a minimally invasive procedure is available. The objective of this prospective, randomised, controlled study was to compare the results of FACD with those of ACDF in mediolateral soft disc herniations. A total of 103 patients with ACDF or FACD were followed up for two years. In addition to general parameters specific measuring instruments were used. Postoperatively 85.9% of the patients no longer had arm pain, and 10.1% had occasional pain. There were no significant clinical differences between the decompression with or without fusion. The full-endoscopic technique afforded advantages in operation technique, rehabilitation and soft tissue injury. The recorded results show that FACD is a sufficient and safe alternative to conventional procedures when the indication criteria are fulfilled. At the same time, it offers the advantages of a minimally invasive intervention.

A Meta-Analysis Comparing the Results of Cervical Disc Arthroplasty with Anterior Cervical Discectomy and Fusion (ACDF) for the Treatment of Symptomatic Cervical Disc Disease

“…Screw failure, joint subluxation, and high rates of dysphagia occurred in patients who underwent procedures with this implant 19 . More recent models such as the Bryan, ProDisc-C, Prestige ST, and PCM appear to provide better results and have fewer prosthesis-related complications 12,13,20 , which may be the reason why fewer supplemental fixations and revisions were required in the arthroplasty group. Although the two groups had similar removal and reoperation rates, the difference in the overall rate of secondary surgical procedures required was significant.…”

“…In vitro studies supported the conclusion that anterior cervical discectomy and fusion at the operated level increases intersegmental motion as well as load and intradiscal pressure at the adjacent levels and may induce progressive disc degeneration at these levels 9 . Some studies have also shown a relationship between the loss of range of motion at the operated level after this procedure and persistent neck pain, poor functional recovery, cervical instability, or even development of accelerated adjacent-level disc degeneration, which is one of the main reasons for the failure of this treatment 2,[11][12][13][14] . Hilibrand et al 15 reported the annual incidence of symptomatic adjacent-level disc degeneration after fusion to be 2.9%.…”

Minimally invasive spine technology and minimally invasive spine surgery: a historical review

“…1 Epstein suggests that there is negative risk-benefit ratio in the use of MIS cervical foraminotomies and favors the use of open techniques, 30 but it is our opinion that complications are avoided by eliminating use of guidewires to begin the process of soft tissue dilation. In 2008, MIS-ACDF using endoscopic techniques was reported by Ruetten et al 111 In the same year, anterior cervical nucleoplasty using percutaneous techniques in cadavers was described by Li et al 76 The use of MAST for cervical instrumentation has been described. Wang and colleagues 130 were the first to report on its clinical use in the placement of lateral mass screws.…”

Endoscopic Minimally Invasive Neurosurgery: Emerging Techniques and Expanding Role through an Extensive Review of the Literature and Our Own Experience – Part II: Extraendoscopic Neurosurgery

“…In their study, the feasibility of an anterior endoscopic approach showed that the anterior elements at all levels of the cervical spine could be easily accessed by a retractor-mounted endoscope. In a recent randomized clinical trial by Ruetten et al [80], no significant differences in clinical outcomes and complications were found in anterior cervical decompression and fusion compared with full endoscopic anterior cervical discectomy for mediolateral soft disc herniation. Both approaches offered good clinical results, with 85.9% of the patients having complete radicular pain resolution at the 2-year follow-up.…”