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Decompression for cervical disc herniation using the full-endoscopic anterior technique

Dekompression beim zervikalen Bandscheibenvorfall in vollendoskopischer, ventraler Technik

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Abstract

Objective

Resection of a cervical disc herniation using a full-endoscopic technique with an anterior approach.

Indication

Fresh disc herniation with monoradicular symptoms in the upper extremity.

Contraindications

Pure neck pain, cervical myelopathy, older and calcified disc herniations, higher grade of instability and deformity.

Surgical technique

Introduction of a guidewire and dilatator to a cervical disc using an anterior approach. Under full-endoscopic view, preparation of the posterior parts of the annulus, opening of the annulus and posterior longitudinal ligament and resection of the herniated fragment from the epidural space.

Postoperative management

Immediate mobilisation, isometric/coordinative exercises, functional exercises from week 3, building up strength from week 6.

Results

A total of 120 patients were operated using the full-endoscopic or microsurgically assisted technique and were followed up for 24 months. Significant improvement was achieved in both groups. The group of full-endoscopic operated patients returned to work significantly earlier and 89% of all patients would undergo the operation again.

Zusammenfassung

Operationsziel

Entfernung eines frischen zervikalen Bandscheibenvorfalls in vollendoskopischer Technik mittels ventralem Zugang.

Indikation

Frischer Bandscheibenvorfall mit monoradikulärer Symptomatik der oberen Extremität.

Kontraindikationen

Reine Nackenschmerzen, zervikale Myelopathie, alte verkalkte Bandscheibenvorfälle, höhergradige Instabilität und Deformität.

Operationstechnik

Einführen eines Führungsdrahts in eine zervikale Bandscheibe von ventral, in Dilatatortechnik Einbringen der Operationshülse. Unter vollendoskopischer Sicht Präparation zum dorsalen Annulus, Eröffnung des Anulus und des posterioren longitudinalen Ligaments sowie Resektion des Sequesters aus dem Epiduralraum.

Weiterbehandlung

Sofortige Mobilisation, isometrische/koordinative Übungen, ab der 3. Woche funktionelle Übungen, ab der 6. Woche Muskelaufbau.

Ergebnisse

Insgesamt wurden 120 Patienten in vollendoskopischer oder mikrochirurgisch assistierter Technik operiert und über 2 Jahre nachuntersucht. Signifikante Verbesserungen wurden in beiden Gruppen erreicht. Die Gruppe der vollendoskopisch operierten Patienten kehrte signifikant früher in den Beruf zurück. Etwa 89 % aller Patienten würden den Eingriff erneut durchführen lassen.

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References

  1. Smith GW, Robinson RA (1958) The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40-A(3):607–624

    Article  CAS  Google Scholar 

  2. Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15(6):602–617

    Article  CAS  Google Scholar 

  3. Fraser JF, Hartl R (2007) Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6(4):298–303

    Article  Google Scholar 

  4. Villavicencio AT et al (2007) The safety of instrumented outpatient anterior cervical discectomy and fusion. Spine J 7(2):148–153

    Article  Google Scholar 

  5. Fountas KN et al (2007) Anterior cervical discectomy and fusion associated complications. Spine 32(21):2310–2317

    Article  Google Scholar 

  6. Maiman DJ et al (1999) Biomechanical effect of anterior cervical spine fusion on adjacent segments. Biomed Mater Eng 9(1):27–38

    CAS  PubMed  Google Scholar 

  7. Lin CY et al (2009) Stress analysis of the interface between cervical vertebrae end plates and the Bryan, Prestige LP, and ProDisc-C cervical disc prostheses: an in vivo image-based finite element study. Spine 34(15):1554–1560

    Article  Google Scholar 

  8. Mummaneni PV et al (2007) Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine 6(3):198–209

    Article  Google Scholar 

  9. Pickett GE et al (2006) Complications with cervical arthroplasty. J Neurosurg Spine 4(2):98–105

    Article  Google Scholar 

  10. Dowd GC, Wirth FP (1999) Anterior cervical discectomy: is fusion necessary? J Neurosurg 90(1 Suppl):8–12

    CAS  PubMed  Google Scholar 

  11. Nandoe Tewarie RD, Bartels RH, Peul WC (2007) Long-term outcome after anterior cervical discectomy without fusion. Eur Spine J 16(9):1411–1416

    Article  Google Scholar 

  12. Oktenoglu T et al (2007) Anterior cervical microdiscectomy with or without fusion. J Spinal Disord Tech 20(5):361–368

    Article  Google Scholar 

  13. Ahn Y, Lee SH, Shin SW (2005) Percutaneous endoscopic cervical discectomy: clinical outcome and radiographic changes. Photomed Laser Surg 23(4):362–368

    Article  Google Scholar 

  14. Saringer W et al (2002) Microsurgical anterior cervical foraminotomy (uncoforaminotomy) for unilateral radiculopathy: clinical results of a new technique. Acta Neurochir (Wien) 144(7):685–694

    Article  CAS  Google Scholar 

  15. Pechlivanis I et al (2008) Treatment of degenerative cervical disc disease with uncoforaminotomy –intermediate clinical outcome. Minim Invasive Neurosurg 51(4):211–217

    Article  CAS  Google Scholar 

  16. Johnson JP et al (2000) Anterior cervical foraminotomy for unilateral radicular disease. Spine 25(8):905–909

    Article  CAS  Google Scholar 

  17. Botelho RV et al (2012) The choice of the best surgery after single level anterior cervical spine discectomy: a systematic review. Open Orthop J 6:121–128

    Article  Google Scholar 

  18. Martins AN (1976) Anterior cervical discectomy with and without interbody bone graft. J Neurosurg 44(3):290–295

    Article  CAS  Google Scholar 

  19. Sonntag VK, Klara P (1976) Controversy in spine care. Is fusion necessary after anterior cervical discectomy? Spine 21(9):1111–1113

    Article  Google Scholar 

  20. Kambin P, Zhou L (1996) History and current status of percutaneous arthroscopic disc surgery. Spine 21(24 Suppl):57S–61S

    Article  CAS  Google Scholar 

  21. Lew SM, Mehalic TF, Fagone KL (2001) Transforaminal percutaneous endoscopic discectomy in the treatment of far-lateral and foraminal lumbar disc herniations. J Neurosurg 94(2 Suppl):216–220

    CAS  PubMed  Google Scholar 

  22. Ruetten S, Komp M, Godolias G (2005) An extreme lateral access for the surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach-technique and prospective results of 463 patients. Spine 30(22):2570–2578

    Article  Google Scholar 

  23. Ruetten S, Komp M, Godolias G (2006) A New full-endoscopic technique for the interlaminar operation of lumbar disc herniations using 6‑mm endoscopes: prospective 2‑year results of 331 patients. Minim Invasive Neurosurg 49(2):80–87

    Article  CAS  Google Scholar 

  24. Ruetten S et al (2007) Use of newly developed instruments and endoscopes: full-endoscopic resection of lumbar disc herniations via the interlaminar and lateral transforaminal approach. J Neurosurg Spine 6(6):521–530

    Article  Google Scholar 

  25. Ruetten S et al (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33(9):931–939

    Article  Google Scholar 

  26. Ruetten S et al (2009) Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 22(2):122–129

    Article  Google Scholar 

  27. Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: surgical technique, outcome, and complications in 307 consecutive cases. Spine 27(7):722–731

    Article  Google Scholar 

  28. Ruetten S et al (2007) A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2‑year results of 87 patients. Minim Invasive Neurosurg 50(4):219–226

    Article  CAS  Google Scholar 

  29. Ruetten S et al (2008) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine 33(9):940–948

    Article  Google Scholar 

  30. Ruetten S et al (2009) Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop 33(6):1677–1682

    Article  Google Scholar 

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Authors and Affiliations

  1. Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und Unfallchirurgie, St. Elisabeth Gruppe—Katholische Kliniken Rhein-Ruhr, St. Anna Hospital Herne, Hospitalstraße 19, 44649, Herne, Germany

    S. Oezdemir, M. Komp, P. Hahn & S. Ruetten

Authors
  1. S. Oezdemir
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  2. M. Komp
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  3. P. Hahn
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  4. S. Ruetten
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Corresponding author

Correspondence to S. Oezdemir.

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Conflict of interest

S. Oezdemir, M. Komp, P. Hahn and S. Ruetten declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

The supplement containing this article is not sponsored by the industry.

Additional information

Editor

H. M. Mayer, Munich

Illustrator

R. Himmelhan, Mannheim

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Oezdemir, S., Komp, M., Hahn, P. et al. Decompression for cervical disc herniation using the full-endoscopic anterior technique. Oper Orthop Traumatol 31 (Suppl 1), 1–10 (2019). https://doi.org/10.1007/s00064-018-0531-2

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  • DOI: https://doi.org/10.1007/s00064-018-0531-2

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