Abstract

Purpose: To demonstrate outpatient anterior endoscopic microdecompressive cervical discectomy and foraminal decompression (foraminoplasty), by utilizing GPS (grid positional system), can treat herniated cervical discs and cervical foraminal stenosis efficaciously and successfully, by mechanical decompression and application of lower level non-ablative Holmium laser for laser thermodiskoplasty (disc shrinking and tightening effect). Materials and Methods: Since 1995, 2066 patients (3730 Discs), who failed at least 12 weeks of conservative care were treated. Levels were C2 to C7, inclusive. All patients demonstrated unilateral radicular pain of a specific dermatome, single level or multiple levels, confirmed with EMG/NCV. MRI or CT scans demonstrated the herniated cervical disc. The surgical technique of anterior endoscopic microdecompressive cervical discectomy foraminal decompression (foraminoplasty) and laser thermodiskoplasty (non-ablative lower Holmium laser energy for disc shrinkage) are described. The surgical approach guided and facilitated with GPS (grid positional system), is explained. Results: For single level, 94% had good to excellent symptomatic relief and spinal motion preservation. 6% of patients had some persistent neck and upper extremity residual but diminished pain associated with parasthesia, after surgery. Average time to return to work was ten to fourteen days. At an average follow-up of 48 months. There were no intraoperative complications. Postoperatively, one patient with transient Horners syndrome and one transient hoarseness voice were noted. Conclusion: The surgery of anterior endoscopic microdecompressive cervical discectomy and foraminal decompression with mechanical decompression and lower level non-ablative Holmium laser for disc shrinking and tightening effect (laser thermodiskoplasty) with GPS has proven to be safe, less traumatic, easier, and efficacious with significant economic savings. It preserves spinal motion. It is an effective alternative or replacement for conventional open cervical spinal surgery for discectomy, and can decompress foraminal stenosis, in degenerative spine disease. References: 1.Chiu J, Endoscopic Assisted microdecompression of Cervical Disc and Foramen In, Szabo Z, Coburg AJ, Savalgi R, Reich H, Yamamotto M, eds. Surgical Technology International XVII, UMP, San Francisco, CA 2008: p.269-279 2.Ascher PW: Application of the laser in neurosurgery. Lasers Surg Med 2:9197, 1986 3.Bailey RW, Badgley CE: Stabilization of the cervical spine by anterior fusion. J Bone Joint Surg Am 42A:565569, 1960 4.Bernhardt M, Gurganious LR, Bloom DL, et al.: 3D magnetic resonance imaginganalysis of percutaneous discectomy. A preliminary report. Spine 18:21l217, 1993 5.Bonafe A, Tremoulet M, Sabatier J, et al.: Foraminal and lateroforaminal herniation. Mid-term results of percutaneous techniques for nucleolysis-nucleotomy. Neurochirurgie 39:110115, 1993 6.Bonaldi G, Minonzio G, Belloni G: Percutaneous cervical discectomy: Preliminary experience. Neuroradiology 36:483486, 1994 7.Castro WH, Halm H, Rondhuis J: The influence of automated percutaneous lumbar discectomy (APLD) on the biomechanics of the lumbar intervertebral disc. An ex- perimental study. Acta Orthop Belg 58:400405, 1992 8.Castro WH, Jerosch J, Brinkmann P: Changes in the lumbar disk following use of non-automated percutaneous discectomy. A biomechanical study. Z Orthop lhre Grenzeb 130:472478, 1992 9.Castro WH, Jerosch J, Hepp R, et al.: Restriction of indication for automated percutaneous lumbar discectomy based on computed tomographic discography. Spine 17:12391243, 1992 10.Chiu JC, Hansraj K, Akiyama B, et al.: Percutaneous microdecompression discectomy for non extruded cervical herniated nucleus pulposus; Surg Technol Int VI:405411, 1997 11.Chiu JC, Clifford TJ, Negron F, et al.: Microdecompressive percutaneous discectomy: Spinal discectomy with new laser thermodiskoplasty for non-extruded herniated nucleus pulposus. Surg Technol Int VIII:343-351,1999 12.Chiu J, Clifford T, Greenspan M. Percutaneous microdecompressive endoscopic cervical discectomy with laser thermodiskoplasty. Mt Sinai J. of Med 2000;67:278-282. 13.Chiu J, Clifford T, Sison R. Anterior Endoscopic Cervical Microdiscectomy: In: Savitz M, Chiu J, Rauschning W, Yeung A, eds. The Practice of Minimally Invasive Spinal Technique: 2005 Edition, AAMISS Press, New City, New York, 2005: 54:p409-414 14.Chiu, J., Clifford, T. Cervical endoscopic discectomy with laser thermodiskoplasty. In: Savitz MH, Chiu JC, Yeung AT, eds. The Practice of Minimally Invasive Spinal Technique, AAMISMS Education, Richmond; 2000:141-148 15.Chiu J, Clifford T, Multiple herniated discs at single and multiple spinal segments treated with endoscopic microdecompressive surgery. J Minim Invasive Spinal Tech 2001;1:15-19. 16.Chiu J, Avoidance of Complications in Minimally Invasive Spinal Surgery. J Min Inv Spinal Tech; 3:1 pp 8-10, 2003 17. Chiu J, Digital Technology Assisted Minimally Invasive Spinal Surgery (MISS) for Spinal Motion Preservation. In: Lemke H.U, Vannier MN, Invamura RD, eds. Computer Assisted Radiology and Surgery. Amsterdam, San Diego, Oxford, London; Elsevier Medical Publisher; 2004, pp 461-466. 18.Chiu, J., Anterior Endoscopic Cervical Microdiscectomy. In Kim D, Fessler R, Regan J, eds. Endoscopic Spine Surgery and Instrumentation. New York: Thieme Medical Publisher; December 2004: Chapter 5, pp 48-58. 19. Cloward RB: The anterior approach for removal of ruptured cervical discs. J Neurosurg 15:602605, 1958 20.Cloward RB: The treatment of ruptured lumbar intervertebral discs by vertebral body fusion. J Neurosurg 10:1519, 1983 21.Fukushima T, Ishijima B, Hirakawa K, et al.: Ventriculofiberscope: A new technique for endoscopic diagnosis and operation. J Neurosurg 38:251256, 1973 22.Hijikata S: Percutaneous nucleotomy: A new concept technique and 12 years experience. Clin Orthop 238:923, 1989 23.Hirsch D: Cervical disc rupture: Diagnosis and therapy. Acta Orthop Scand 30:172176, 1960 25.Kahanovitz N, Viola K, Goldstein T, et al.: A multicenter analysis of percutaneous discectomy. Spine 15:713715, 1990 26.Key CA: On paraplegia depending on the ligaments of the spine. Guys Hosp Rep 7:17371739, 1838 27.Kotilainen E, Alanen A, Erkintalo M, et al.: Magnetic resonance image changes and clinical outcome after microdiscectomy or nucleotomy for ruptured disc. Surg Neurol 41:432440, 1994 28.Mixter WJ, Barr JS: Rupture of the intervertebral disc with involvement of the spinal canal. N Engl J Med 211:210215, 1934 29.Onik G, Maroon JC, Davis GW: Automated percutaneous discectomy: A prospective multi-institutional study. Neurosurgery 26:228231, 1990 30.Robertson YR: Anterior removal of cervical disc without fusion. Clin Neurosurg 20:259262, 1973 31.Robinson RA, Smith GW: Anterolateral cervical disc removal and interbody fusion for cervical disc syndrome. Bull Johns Hopkins Hosp 96:223224, 1955 32.Sherk HH: Lasers in Orthopaedics, JB Lippincott, Philadelphia, PA, 1990, pp 8590 33.Smith L: Enzyme dissolution of the nucleus pulposus in humans. JAMA 187:137-140, 1964 34.Smith L, Garvin PJ, Jennings RB, et al.: Enzyme dissolution of the nucleus pulposus. Nature 198:13111312, 1963 35.Stookey B: Compression of the spinal cord due to ventral extradural cervical chondromas. Arch Neurol Psych 20:275278, 1928 36.Ulrich HW: Automated percutaneous discectomy: Indication, technique and results after 2 years. Z Orthop lhre Belg 130:4550, 1992 37.Yeo SJ, Tay BK: Clinical experience with automated percutaneous discectomy. Singapore Med J 34:313315, 1993 38.Zhou YC, Wang CY: Percutaneous lumbar discectomy using a new nucleotome system. Report of 182 cases. Chin Med J 106:446451, 1993 39.Zhou YC, Zhou YQ, Wang CY: Percutaneous cervical discectomy for treating cervical disc herniation-- a report of 12 cases. J Tongji Med Univ 14:110113, 1994