Abstract

As a bridge between open and percutaneous therapy, endoscopy of the cervical spine started to be used at the beginning of the 1990s beside the nonendoscopic percutaneous cervical decompression, following good experiences on the lumbar spine. The principle of microsurgery is combined with the minimally invasive principles by bringing the optical level to the forefront of pathology. Access morbidity has been significantly reduced by the percutaneous access technique. Furthermore, a large proportion of the intervertebral disc, in particular most of the fibrous ring, is preserved. The pathology is only removed selectively in the area of the nucleus pulposus and on the dorsal fibrous ring. This preserves the remaining biomechanical function of the degenerated intervertebral disc. Stabilisation and ablation is possible by a steerable probe with highfrequency radiowave. By means of tried and tested minimally invasive methods under vision, such as the use of a laser or radiowave to ablate and shrink tissue, the risk of complications has been further reduced, at the same time as enhancing efficiency. The advancement of the endoscopic technique with increased miniaturization of the scope and working options led to a restriction of use. So that on the other side a nonendoscopic procedure guided flouroscopicly can replace very small endoscopes. The major factors favouring the cervical nonendoscopic procedure by NdYag Laser are the pressure reduction achievable by vaporisation of the intervertebral disc and the shrinking as a technique for pressure relief in the spinal channel. After 15 years of experience with the cervical PLDN we started with the percutaneous cervical endoscopic nucleotomy in 2004 as further opportunity for cervical discal herniations to avoid an open surgery. It seemed that both has been competing procedures by similar indications, whereas for the PECD also noncontained extrusions on the disc level have been treated too. Our aim was to compare bothe methods in the outcome and the savety. From a group of 30 cases 14 Patients underwend PLDN and 16 PECD. Thereby we got by subjective McNab questionaire 65% for the PLDN and 76% for the PECD for excellent and good results after 6 weeks. Objectively the pain improved by PLDN from VAS 8,4 to 3,2 by PLDN and from 8,6 to 2,4 by PECD. By both methods neurological deficits disappeared. Conclusion: The investigation shows that the minimal invasive procedures PLDN and PECD are working well and are able to avoid in nearly all cases an open surgery. Meanwhile the Laser procedure is simple, save and fast, the endoscopic approach allows a visual controlled decompression and use of radiowave into the epidural space. In ouer cases were no complications and the complication rate reported until now is much more lower than by open surgery. For selected cases both procedures will be an estimable third way in addition to dorsal and ventral surgical accses.