Treatment of cervical spondylotic radiculopathy with posterior percutaneous endoscopic cervical discectomy

Abstract

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.

Microscopic Anterior Cervical Discectomy and Fusion Versus Posterior Percutaneous Endoscopic Cervical Keyhole Foraminotomy for Single-level Unilateral Cervical Radiculopathy

“…Owing to the large difference in sample sizes of the studies on PPEKF, the overall postoperative complications greatly varied. Some studies did not report any complications, 12 , 26 , 28 but one study reported an overall complication rate as high as 14.3%. 16 However, the specific proportions of several common complications showed significant differences.…”

“…The rapid development of endoscopic technique has made the posterior cervical foraminotomy (PCF) minimally invasive, avoiding the injury of the large surgical incision to the paravertebral muscles. 11,12 So posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) has become an alternative technique to open discectomy in the posterior cervical approach, especially for single-level unilateral cervical radiculopathy. 13,14 Few previous studies and meta-analysis have compared the therapeutic effects of ACDF and PCF in the treatment of cervical radiculopathy.…”

“…The posterior cervical approach can avoid these complications caused by the anterior cervical approach. The rapid development of endoscopic technique has made the posterior cervical foraminotomy (PCF) minimally invasive, avoiding the injury of the large surgical incision to the paravertebral muscles 11,12. So posterior percutaneous endoscopic keyhole foraminotomy (PPEKF) has become an alternative technique to open discectomy in the posterior cervical approach, especially for single-level unilateral cervical radiculopathy 13,14…”

Morphology of Herniated Disc as a Predictor for Outcomes of Posterior Percutaneous Full‐endoscopic Cervical Discectomy in Treating Cervical Spondylotic Radiculopathy

“…According to our intraoperative experience of PPECD, herniated discs with less than 33.785° of CDHCA were commonly located at infra‐axillary or anterior region of the nerve root. This anatomical relationship between the herniated disc and nerve root requires an extended excision of ligamentum flavum, which consequently leads to more bleeding and influences endoscopic visuality 24 . In addition, there exists an underlying physiological relationship between the variation of CDHCA and motion of cervical cord.…”

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

“…Cervical spondylotic radiculopathy (CSR) is often caused by nerve compression due to cervical disc herniation, intervertebral foramen stenosis, and hyperplastic osteophytes 1 , 2 . Its main symptoms include pain in the neck and upper limbs, with or without numbness, and with surgical treatment needed in severe cases 3 . Since its first proposal by Smith and Robinson in 1955 4 , anterior cervical discectomy and fusion (ACDF) has been regarded as the gold standard for CSR treatment.…”