Full-endoscopic posterior operation of cervical lateral disc herniations – Prospective, randomized comparison to anterior cervical decompression and fusion (ACDF)

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Semih Oezdemir


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Citation: S. Oezdemir : Full-endoscopic posterior operation of cervical lateral disc herniations – Prospective, randomized comparison to anterior cervical decompression and fusion (ACDF). The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4

Abstract

Background: There are various techniques for the operation of cervical disc herniations. The most common today appears to be ventral decompression and fusion. It brings good results, but requires more major surgery with loss of segment mobility. Dorsal "keyhole foraminotomy" is also been used without fusion. This operation is now possible in a full-endoscopic technique. Objective: The objective of the prospective randomized study was to compare ventral decompression and fusion (Group 1) to full-endoscopic dorsal decompression (Group 2) in lateral, soft disc herniations. Patients and methods: 70 patients were operated (35 per group). Inclusion criteria were: monosegmental mediolateral and lateral soft disc herniation, radicular pain. In Group 1, the operation was performed in known technique using a PEEK cage without plating. In Group 2, the operation was performed using 5.8-mm endoscopes with a 3.2-mm intraendoscopic working canal under continuous lavage. The follow-up lasted 24 months. 62 patients (88 %) were followed. Results: The mean operation time in Group 1 was 75 minutes, in Group 2 35 minutes. There were no measurable blood loss and serious complications in either group. In Group 1, 2 patients had transient difficulty swallowing. In Group 2, transient numbness occurred twice. There was no operation-related neck pain in Group 2 after wound healing. One patient in Group 2 suffered recurrence. CT-examinations showed resection of less than 1/4 of the facets in Group 2. There was no increasing instability or kyphosing in Group 2, in Group 1 no adjacent instability. 57 patients subjectively attained a satisfactory result. This corresponded to the significantly constant improvement recorded by the validated measuring instruments. There were no significant differences between the groups. Conclusion: Full-endoscopic dorsal foraminotomy is technically feasible and a potential alternative to ventral decompression and fusion. It enables a selective procedure with direct visualization, decompression is rapid, sufficient and the complication rate is low. Traumatization of the access pathway and the structures of the spinal canal is reduced due to the minimally invasive technique. Strict attention must be paid to the indication for lateral and soft disc herniation. Recurrences cannot be ruled out.

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