Abstract
Objective
Surgery for cervical disc herniation with full-endoscopic posterior access.
Indications
Cervical disc herniation and neuroforaminal pathology with radicular symptoms.
Contraindications
Neck pain alone, cervical myelopathy or pathologies with central nervous system symptoms, instabilities requiring correction/instabilities.
Surgical technique
Introduction of a surgical tube to the facet joint at the level to be operated on. Resection of bony and ligamentous parts of the cervical spinal canal under endoscopic guidance. Visualisation of the disc herniation and decompression of the neural structures.
Postoperative management
Immediate mobilisation, specific rehabilitative physiotherapy depending on pre-existing neurological deficits.
Results
A total of 87 patients underwent full-endoscopic posterior surgery and were followed over a period of 2 years. Significant improvement was observed. No serious complications occurred. In all, 5 patients underwent revision in the follow-up period. Of the patients, 93% would undergo the procedure again.
Zusammenfassung
Operationsziel
Operation zervikaler Bandscheibenvorfälle mit einem dorsalen vollendoskopischen Zugang.
Indikationen
Zervikale Bandscheibenvorfälle und Pathologien im Neuroforamen mit radikulärer Symptomatik.
Kontraindikationen
Reiner Nackenschmerz, zervikale Myelopathie oder Pathologien mit zentralnervöser Symptomatik, korrekturbedürftige Instabilitäten/Instabilitäten.
Operationstechnik
Einbringen einer Operationshülse auf das Facettengelenk der zu operierenden Etage. Unter endoskopischer Sicht Resektion von knöchernen und ligamentären Anteilen des zervikalen Spinalkanals. Darstellen des Bandscheibenvorfalls und Dekompression der neuralen Strukturen.
Weiterbehandlung
Sofortige Mobilisation, weiche Halsorthese bis zur Wundheilung, spezifische rehabilitative physiotherapeutische Maßnahmen in Abhängigkeit von vorbestehenden neurologischen Defiziten.
Ergebnisse
Insgesamt wurden 87 Patienten vollendoskopisch dorsal operiert und über 2 Jahre nachuntersucht. Dabei zeigte sich eine signifikante Verbesserung. Schwere Komplikationen traten nicht auf. Im Nachbeobachtungszeitraum wurden 5 Patienten revidiert. Den Eingriff würden 93 % der Patienten erneut durchführen lassen.
Similar content being viewed by others
References
Bohlmann HH, Emery SE, Goodfellow DB, Jones K (1993) Anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am 75:1298–1307
Cauthen JC, Kinard R, Vogler JB, Jackson DE, DePaz OB, Hunter OL, Wasserburger LB, Williams VM (1998) Outcome analysis of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients. Spine 23:188–192
Epstein NE (2002) A review of laminoforaminotomy for the management of lateral and foraminal cervical disc herniations or spurs. Surg Neurol 57:226–233
Fager CA (1977) Management of cervical disc lesions and spondylosis by posterior approaches. Clin Neurosurg 24:488–507
Fessler RG, Khoo LT (2002) Minimally invasive microendoscopic foraminotomy: an initial clinical experience. Neurosurgery 51:37–45
Fontanella A (1999) Endoscopic microsurgery in herniated cervical discs. Neurol Res 21:31–38
Fraser JF, Hartl R (2007) Anterior approaches to fusion of the cervical spine: a metaanalysis of fusion rates. J Neurosurg Spine 6:298–303
Hakuba A (1976) A combined anterior and lateral approach to cervical discs. J Neurosurg 45:284–291
Henderson CM, Hennessy RG, Shuey HM, Shackelford EG (1983) Posterio-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery 13:504–512
Hilton DL Jr (2007) Minimally invasive tubular access for posterior cervical foraminotomy with three-dimensional microscopic visualization and localization with anterior/posterior imaging. Spine J 7:154–158
Jho HD (1996) Microsurgical anterior cervical foraminotomy. J Neurosurg 84:155–160
Jodicke A, Daentzer D, Kastner S, Asamoto S, Boker DK (2003) Risk factors for outcome and complications of dorsal foraminotomy in cervical disc herniation. Surg Neurol 60:124–129
Komp M, Hahn P, Oezdemir S, Merk H, Kasch R, Godolias G, Ruetten S (2014) Operation of lumbar zygoapophyseal joint cysts using a full-endoscopic interlaminar and transforaminal approach: prospective 2‑year results of 74 patients. Surg Innov 21:605–614
Komp M, Hahn P, Oezdemir S, Giannakopoulos A, Heikenfeld R, Kasch R, Merk H, Godolias G, Puchstein C, Ruetten S (2015) Bilateral decompression of lumbar central stenosis using the full-endoscopic interlaminar technique compared with microsurgical technique: a prospective, randomized, controlled study. Pain Physician 18:61–70
Nabhan A, Ahlhelm F, Pitzen T, Steudel WI, Jung J, Shariat K, Steimer O, Bachelier F, Pape D (2007) Disc replacement using Pro-Disc C versus fusion: a prospective randomized and controlled radiographic and clinical study. Eur Spine J 16:423–430
Nandoe Tewarie RD, Bartels RH, Peul WC (2007) Long-term outcome after anterior cervical discectomy without fusion. Eur Spine J 16:1411–1416
Pedram M, Castagnara L, Carat X, Macouillard G, Vital JM (2003) Pharyngolaryngeal lesions in patients undergoing cervical spine surgery through the anterior approach: contribution of methylprednisolone. Eur Spine J 12:84–90
Pickett GE, Sekhon LH, Sears WR, Duggal N (2006) Complications with cervical arthroplasty. J Neurosurg Spine 4:98–105
Ruetten S, Komp M, Oezdemir S (2014) Current status of full-endoscopic techniques in the surgical treatment of disk herniations and spinal canal stenosis. Chin J Bone Joint 3:571–584
Ruetten S, Komp M, Merk H, Godolias G (2009) Surgical treatment for lumbar lateral recess stenosis with the full-endoscopic interlaminar approach versus conventional microsurgical technique: a prospective, randomized, controlled study. J Neurosurg Spine 10:476–485
Ruetten S, Komp M, Merk H, Godolias G (2009) Recurrent lumbar disc herniation following conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech 22:122–129
Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic interlaminar and transforaminal lumbar discectomy versus conventional microsurgical technique: a prospective, randomized, controlled study. Spine 33:931–939
Ruetten S, Komp M, Godolias G (2005) An extreme lateral access fort he surgery of lumbar disc herniations inside the spinal canal using the full-endoscopic uniportal transforaminal approach.—Technique and prospective results of 463 patients. Spine 30:2570–2578
Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: A prospective, randomized, controlled study. Spine 33:940–948
Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop 33:1677. https://doi.org/10.1007/s00264-008-0684-y
Ruetten S, Komp M, Merk H, Godolias G (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 50:219–226
Tureyen K (2003) Disc height loss after anterior cervical microdiscectomy with titanium intervertebral cage fusion. Acta Neurochir (Wien) 145:565–569
Wang MC, Chan L, Maiman DJ, Kreuter W, Deyo RA (2007) Complications and mortality associated with cervical spine surgery for degenerative disease in the United States. Spine 32:342–347
Woertgen C, Rothoerl RD, Henkel J, Brawanski A (1997) Prognostic factors of posterior cervical disc surgery: a prospective, consecutive study of 54 patients. Neurosurgery 40:724–729
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
M. Komp, S. Özdemir, 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.
Additional information
Editor
M. Mayer, Munich
Illustrator
J. Kühn, Mannheim
Rights and permissions
About this article
Cite this article
Komp, M., Oezdemir, S., Hahn, P. et al. Full-endoscopic posterior foraminotomy surgery for cervical disc herniations. Oper Orthop Traumatol 30, 13–24 (2018). https://doi.org/10.1007/s00064-017-0529-1
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00064-017-0529-1