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Neuroradiology

, Volume 46, Issue 5, pp 378–384 | Cite as

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

  • Y. Ahn
  • S. H. LeeEmail author
  • S. C. Lee
  • S. W. Shin
  • S. E. Chung
Interventional Neuroradiology

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.

Keywords

Percutaneous discectomy Cervical spine Predicting factors Endoscopic laser 

Notes

Acknowledgements

The authors sincerely thank J.H. Hwang, I. Lee, I.S. Cho and H.R. Lee for the help in preparing the manuscript and figures.

References

  1. 1.
    Hijikata S, Yamagishi M, Nakayama T, Oomori K (1975) Percutaneous nucleotomy: a new treatment method for lumbar disc herniation. J Toden Hosp 5:5–13Google Scholar
  2. 2.
    Hijikata S (1989) Percutaneous nucleotomy. A new concept technique and 12 years’ experience. Clin Orthop 238:9–23PubMedGoogle Scholar
  3. 3.
    Onik GM, Kambin P, Chang MK (1997) Minimally invasive disc surgery. Nucleotomy versus fragmentectomy. Spine 22:827–828CrossRefPubMedGoogle Scholar
  4. 4.
    Yeung AT, Tsou PM (2002) Posterolateral endoscopic excision for lumbar disc herniation: Surgical technique, outcome, and complications in 307 consecutive cases. Spine 27:722–731CrossRefPubMedGoogle Scholar
  5. 5.
    Ahn Y, Lee SH, Park WM, Lee HY (2003) Posterolateral percutaneous endoscopic lumbar foraminotomy for L5-S1 foraminal or lateral exit zone stenosis. Technical note. J Neurosurg 99 [Suppl 3]:320–323Google Scholar
  6. 6.
    Courtheoux F, Theron J (1992) Automated percutaneous nucleotomy in the treatment of cervicobrachial neuralgia due to disc herniation. J Neuroradiol 19:211–216PubMedGoogle Scholar
  7. 7.
    Bonaldi G, Minonzio G, Belloni G, et al (1994) Percutaneous cervical discectomy: preliminary experience. Neuroradiology 36:483–486PubMedGoogle Scholar
  8. 8.
    Hoogland T, Scheckenbach C (1995) Low-dose chemonucleolysis combined with percutaneous nucleotomy in herniated cervical disks. J Spinal Disord 8:228–232PubMedGoogle Scholar
  9. 9.
    Siebert W (1995) Percutaneous laser discectomy of cervical discs: preliminary clinical results. J Clin Laser Med Surg 13:205–207PubMedGoogle Scholar
  10. 10.
    Choy DS (1998) Percutaneous laser disc decompression (PLDD): 12 years’ experience with 752 procedures in 518 patients. J Clin Laser Med Surg 16:325–331PubMedGoogle Scholar
  11. 11.
    Hellinger J (1999) Technical aspects of the percutaneous cervical and lumbar laser-disc-decompression and -nucleotomy. Neurol Res 21:99–102PubMedGoogle Scholar
  12. 12.
    Knight MT, Goswami A, Patko JT (2001) Cervical percutaneous laser disc decompression: preliminary results of an ongoing prospective outcome study. J Clin Laser Med Surg 19:3–8CrossRefPubMedGoogle Scholar
  13. 13.
    Chiu JC, Clifford TJ, Greenspan M, Richley RC, Lohman G, Sison RB (2000) Percutaneous microdecompressive endoscopic cervical discectomy with laser thermodiskoplasty. Mt Sinai J Med 67:278–282PubMedGoogle Scholar
  14. 14.
    Lee SH, Gastambide D (2000) Perkutane endoskopische Diskotomie der Halswirbelsaule. In: Pfeil J, Siebert W, Janousek A, et al (eds) Minimal-invasive Verfahren in der Orthopadie und Traumatologie. Springer, Berlin Heidelberg New York, pp 41–61Google Scholar
  15. 15.
    Zhou YC, Zhou YQ, Wang CY (1994) Percutaneous cervical discectomy for treating cervical disc herniation—a report of 12 cases. J Tongji Med Univ 14:110–113PubMedGoogle Scholar
  16. 16.
    Macnab I (1971) Negative disc exploration: An analysis of the causes of nerve root involvement in 68 patients. J Bone Joint Surg (Am) 53:891–903Google Scholar
  17. 17.
    Takahashi K, Koyama T, Igarashi S, Aii H (1987) A classification of the herniated cervical disc based on metrizamide CT. No Shinkei Geka 15:125–130PubMedGoogle Scholar
  18. 18.
    Fischgrund JS, Herkowitz HN (1999) Clinical spondylotic radiculopathy: natural history and pathophysiology. In: Herkowitz HN, Garfin SR, Balderston RA, et al (eds) Rothman-Simeone: The spine, vol. 1, 4th edn. WB Saunders, Philadelphia, pp 461–465Google Scholar
  19. 19.
    Mehalic TF, Pezzuti RT, Applebaum BI (1990) Magnetic resonance imaging and cervical spondylotic myelopathy. Neurosurgery. 26:217–226, discussion 226–227Google Scholar
  20. 20.
    Dai L (1998) Disc degeneration and cervical instability. Correlation of magnetic resonance imaging with radiography. Spine 23:1734–1738CrossRefPubMedGoogle Scholar
  21. 21.
    Benzel EC (1992) Cervical Spondylotic myelopathy: posterior surgical approaches. In: Cooper PR (ed) Degenerative disease of the cervical spine. American Association of Neurological Surgeons, Chicago, pp 91–103Google Scholar
  22. 22.
    Balmaseda MT Jr, Pellioni DJ (1985) Esophagocutaneous fistula in spinal cord injury: a complication of anterior cervical fusion. Arch Phys Med Rehabil 66:783–784PubMedGoogle Scholar
  23. 23.
    Newhouse KE, Lindsey RW, Clark CR, Lieponis J, Murphy MJ (1989) Esophageal perforation following anterior cervical spine surgery. Spine 14:1051–1053PubMedGoogle Scholar
  24. 24.
    Gore DR, Gardner GM, Sepic SB, Murray MP (1986) Roentgenographic findings following anterior cervical fusion. Skeletal Radiol 15:556–559PubMedGoogle Scholar
  25. 25.
    Clements DH, O’Leary PF (1990) Anterior cervical discectomy and fusion. Spine 15:1023–1025PubMedGoogle Scholar
  26. 26.
    Watters WC 3rd, Levinthal R (1994) Anterior cervical discectomy with and without fusion. Results, complications and long-term follow-up. Spine 19:2343–2347PubMedGoogle Scholar
  27. 27.
    Freemont AJ, Peacock TE, Goupille P, Hoyland JA, O’Brien J, Jayson MI (1997) Nerve ingrowth into diseased intervertebral disc in chronic back pain. Lancet 350:178–181PubMedGoogle Scholar
  28. 28.
    McCormick PC (1992) Clinical manifestations of myelopathy and radiculopathy. In: Cooper PR (ed) Degenerative disease of the cervical spine. American Association of Neurological Surgeons, Chicago, pp 1–8Google Scholar
  29. 29.
    Barrios C, Ahmed M, Arrotegui JI, Bjornsson A (1990) Clinical factors predicting outcome after surgery for herniated lumbar disc: an epidemiological multivariate analysis. J Spinal Disord 3:205–209PubMedGoogle Scholar
  30. 30.
    Kim YS, Chin DK, Yoon DH, Jin BH, Cho YE (2002) Predictors of successful outcome for lumbar chemonucleolysis: analysis of 3,000 cases during the past 14 years. Neurosurgery 51 [Suppl 5]:123–128Google Scholar
  31. 31.
    Spangfort EV (1972) The lumbar disc herniation. A computer-aided analysis of 2,504 operations. Acta Orthop Scand [Suppl] 142:1–95Google Scholar
  32. 32.
    Carragee EJ, Kim DH (1997) A prospective analysis of magnetic resonance imaging findings in patients with sciatica and lumbar disc herniation. Correlation of outcomes with disc fragment and canal morphology. Spine 22:1650–1660PubMedGoogle Scholar
  33. 33.
    Batzdorf U, Batzdorff A (1988) Analysis of cervical spine curvature in patients with cervical spondylosis. Neurosurgery 22:827–836PubMedGoogle Scholar
  34. 34.
    Benzel EC, Lancon J, Kesterson L, Hadden T (1991) Cervical laminectomy and dentate ligament section for cervical spondylotic myelopathy. J Spinal Disord 4:286–295PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2004

Authors and Affiliations

  • Y. Ahn
    • 1
  • S. H. Lee
    • 1
    Email author
  • S. C. Lee
    • 1
  • S. W. Shin
    • 2
  • S. E. Chung
    • 2
  1. 1.Department of NeurosurgeryWooridul Spine HospitalSeoulKorea
  2. 2.Department of RadiologyWooridul Spine HospitalSeoulKorea

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