The Internet Journal of Minimally Invasive Spinal Technology™ ISSN: 1937-8254

The Internet Journal of Minimally Invasive Spinal Technology is the official online journal of ISMISS/SICOT (International Society of Minimally Invasive Spinal Surgery, affiliate of SICOT) and AAMISMS (American Academy of Minimally Invasive Spine Surgery and Medicine)

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Percutaneous Endoscopic Cervical Discectomy For Noncontained Cervical Disc Herniation: Minimum 3 Years Follow-Up

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Sang-Ho Lee MD, PhD
Wooridul Spine Hospital (WSH)

June-Ho Lee MD
Wooridul Spine Hospital (WSH)

Sung Min Hur MD
Wooridul Spine Hospital (WSH)

Citation: S. Lee, J. Lee & S. Hur : Percutaneous Endoscopic Cervical Discectomy For Noncontained Cervical Disc Herniation: Minimum 3 Years Follow-Up. The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4

Abstract

Introduction: Although percutaneous endoscopic cervical discectomy (PECD) has been an effective procedure for soft disc herniation, the conventional technique has the risk of spinal cord injury because of the relatively blind approach and straight-firing laser and the difficulty of removal of remnants, especially foraminal fragment. The aim of this study is to present the surgical technique and clinical outcome of PECD using a working channel scope (WSH endoscopy set, Storz, Germany) and a side-firing laser for non contained cervical disc herniation. Methods: Between March 2002 and January 2005, 108 of 114 patients underwent PECD using WSH endoscopies set were available for follow-up. The inclusion criteria were cervical radiculopathy due to foraminal, non contained HCD as demonstrated on CT/MRI scan not responding to at least 6 weeks of conservative therapy. Under the conscious sedation, the patient was placed in supine position with neck extension. After pushing esophagus and trachea to the opposite side, an 18G needle was inserted into the disc space under C-arm guidance. The tract was dilated using serial dilators, and the working channel scope was inserted into disc space. Under the direct visualization, ruptured disc fragment was removed by a microforceps and vaporized by a side-firing Ho:YAG laser through the working channel. The clinical outcomes were assessed by the Visual Analogue Scale (VAS) and the Neck Disability Index (NDI). Results: The mean follow-up period was 42 (range, 24–68) months. There were 66 males (57.9%) and 48 females (42.1%) with a mean age of 48.3 (range 26–68) years. The mean VAS score for neck pain dropped from 7.7 to 3.1. The NDI improved from 36 to 4%. There were 6 cases requiring revisional surgery at the affected levels. There was no associated complication such as infection, hoarseness, esophageal injury or intraoperative neural injury.Conclusion: PECD using a WSH working channel scope provided a safer and effective alternative for the treatment of non contained cervical disc herniation. The WSH working channel scope had several advantages, such as a high quality of optics, a bigger working channel, and a side-firing laser.

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	The Internet Journal of Minimally Invasive Spinal Technology™ ISSN: 1937-8254 \| Home \| Editors \| Current Issue \| Archives \| Instructions for Authors \| Disclaimer \| Share with others \| The Internet Journal of Minimally Invasive Spinal Technology is the official online journal of ISMISS/SICOT (International Society of Minimally Invasive Spinal Surgery, affiliate of SICOT) and AAMISMS (American Academy of Minimally Invasive Spine Surgery and Medicine) Percutaneous Endoscopic Cervical Discectomy For Noncontained Cervical Disc Herniation: Minimum 3 Years Follow-Up Read printer friendly Subscribe in a reader Share with others Sang-Ho Lee MD, PhD Wooridul Spine Hospital (WSH) June-Ho Lee MD Wooridul Spine Hospital (WSH) Sung Min Hur MD Wooridul Spine Hospital (WSH) Citation: S. Lee, J. Lee & S. Hur : Percutaneous Endoscopic Cervical Discectomy For Noncontained Cervical Disc Herniation: Minimum 3 Years Follow-Up. The Internet Journal of Minimally Invasive Spinal Technology. 2009 Supplement II - to IJMIST Vol III No 4 Abstract Introduction: Although percutaneous endoscopic cervical discectomy (PECD) has been an effective procedure for soft disc herniation, the conventional technique has the risk of spinal cord injury because of the relatively blind approach and straight-firing laser and the difficulty of removal of remnants, especially foraminal fragment. The aim of this study is to present the surgical technique and clinical outcome of PECD using a working channel scope (WSH endoscopy set, Storz, Germany) and a side-firing laser for non contained cervical disc herniation. Methods: Between March 2002 and January 2005, 108 of 114 patients underwent PECD using WSH endoscopies set were available for follow-up. The inclusion criteria were cervical radiculopathy due to foraminal, non contained HCD as demonstrated on CT/MRI scan not responding to at least 6 weeks of conservative therapy. Under the conscious sedation, the patient was placed in supine position with neck extension. After pushing esophagus and trachea to the opposite side, an 18G needle was inserted into the disc space under C-arm guidance. The tract was dilated using serial dilators, and the working channel scope was inserted into disc space. Under the direct visualization, ruptured disc fragment was removed by a microforceps and vaporized by a side-firing Ho:YAG laser through the working channel. The clinical outcomes were assessed by the Visual Analogue Scale (VAS) and the Neck Disability Index (NDI). Results: The mean follow-up period was 42 (range, 24–68) months. There were 66 males (57.9%) and 48 females (42.1%) with a mean age of 48.3 (range 26–68) years. The mean VAS score for neck pain dropped from 7.7 to 3.1. The NDI improved from 36 to 4%. There were 6 cases requiring revisional surgery at the affected levels. There was no associated complication such as infection, hoarseness, esophageal injury or intraoperative neural injury.Conclusion: PECD using a WSH working channel scope provided a safer and effective alternative for the treatment of non contained cervical disc herniation. The WSH working channel scope had several advantages, such as a high quality of optics, a bigger working channel, and a side-firing laser. This article was last modified on Fri, 03 Jul 09 14:16:42 -0500 This page was generated on Sat, 07 Nov 09 10:28:26 -0600, and may be cached.
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