Abstract

There is a high incidence of cervical discogenic pain symptoms in the population. It is estimated that one person in five in Germany who visits an orthopedist presents with the symptoms of a cervical disc syndrome. The treatment of cervical discogenic diseases makes high demands in terms of both diagnostics and therapy. Diagnostics has been made easier by improved imaging and the enhancement of neurological measuring methods. Consequently, there is now interdisciplinary consensus that the principal pathologic causes can be reliably identified. With the aid of appropriate conservative therapy, approximately 80 percent of all cervical syndromes can be cured. Only once all the conservative and semi-invasive procedures have been exhausted should surgery be considered.The first step in the interventional treatment of cervical syndrome is in our opinion the non endoscopic decompression and nucleotomy by Laser introduced 1990 by J. Hellinger. The technique is simple and will be demonstrated. As a bridge between open and percutaneous therapy, endoscopy of the cervical spine started to be used at the beginning of the 1990s, 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. By means of tried and tested minimally invasive methods under vision, such as the use of a laser or radiofrequency to ablate and shrink tissue, the risk of complications has been further reduced, at the same time as enhancing efficiency. Meanwhile segmental fusions if necessary are by the endoscopic technique performed. The indications for both procedures are neck pain radiating into the arm (radicular pain), symptoms of segmental dysesthesia, and motor deficits matching the pathologic segment, conservative therapy resistant vertebrogenic headache with reliable imaging, disc herniation confirmed by MRI or CT, with associated clinical picture, damage in adjoining segments after preceding fusion, with corresponding clinical picture, and multisegment disc herniations. This method cannot be used in cases of serious cervical spinal stenosis, migrated free sequestra, pronounced spondylosis with large osteophytes, and calcifications of the posterior spinal ligament. The results of this methods display a success rate of 80% - 95% for good to very good outcomes. This includes various work techniques of endoscopic cervical decompression, such as laser. Our experience also confirms this success rate.The complication rate of percutaneous cervical decompression is extremely small, as is the case with non endoscopic percutaneous procedures. Inadequate decompression when using the non endoscopic or the endoscopic technique will be reflected in the incidence of secondary operations. Summary:The non endoscopic percutaneous Laser disc decompression and nucleotomy as well as the selective percutaneous endoscopic decompression and nucleotomy are safe and efficient alternatives to conventional anterior cervical discectomy, with or without fusion, for the treatment of discogenic syndromes of the cervical spine. It entails less surgical trauma, and considerably reduces surgery related stress for the patient, while also shortening the period of hospitalization and the operating time. With the new devices for this procedure we got further possibilities in the current treatment of cervical disc disease and for development of new opportunities.