Abstract

Background Because of the fear of complications related to conventional treatment for cervical disc herniations, minimal invasive procedures gain significant interest in patients and spine surgeons. Purpose The purpose of this study was to evaluate the effectiveness and complication rate of an anterior percutaneous minimal invasive surgical treatment. Study Design A prospective clinical study. Patient Sample 95 consecutive patients over a 1 year period with a MRI or CT proven disc-herniation, with or without foraminal stenosis, predominantly radicular symptoms, no previous neck surgery and not responding to conservative treatment. All patients had a two year follow up. Outcome Measures The patients had a clinical evaluation 3 months after surgery and returned at two years an extensive questionnaire including VAS Scores, MacNab Score as well as subjective satisfaction Method Under local anaesthesia a 3 millimetre working cannula was introduced from anterior. Trough this cannula a foraminal decompression was performed with a two millimetre reamer. With special forceps protruded and extruded disc material was removed under control of a X-image intensifier. Results: At the two year follow-up 86,1% of the patients reported an excellent or good result, 12,8% a fair and 1,1% unsatisfactory result. The average arm-pain value improved from the average of 8,7 points pre operative by 6,1 points to 2,6 at two years. The neck-pain value improved from the average 8,3 pre operative to 2,5 at two years, an average improvement of 5,8 points as well. 10 patients needed to be treated because they showed an early recurrent disc herniation (10,5%) within three months. They all had another percutaneous nucleotmie with a 4millimetre cannula and two of these patients had a third surgery one percutaneous procedure again and one had a fusion. After 2 Years 8 patients were very satisfied or satisfied one was unchanged and 1 gave no answer. Further 9 Patients 9,5% had a recurrent disc herniation between three month and 2 years after surgery. 3 Patients were treated percutaneous and 6 patients had a fusion (final fusion rate: 6,3%). After 2 Years four of these patients were very satisfied or satisfied three were unchanged and two gave no answer. Complications: besides the early recurrence there were no complications. Conclusion: This procedure is a delicate but save and effective treatment for cervical disc herniations even in the presence of spondylosis and foraminal stenosis.