- 2021;24;E811-E819Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results
Xi Chen, MD, Jian-An Gao, MD, Qian Du, MD, Yang Qiao, MD, Wei-Jun Kong, MD, and Wen-Bo Liao, MD.
BACKGROUND: Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited.
OBJECTIVES: To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application.
STUDY DESIGN: A retrospective cohort study.
SETTING: A center for spine surgery, rehabilitation department and pain medicine.
METHODS: Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations.
RESULTS: The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body.
LIMITATIONS: This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design.
CONCLUSIONS: Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results.
Trial registration: The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820).
KEY WORDS: Percutaneous full-endoscope, anterior transcorporeal approach, cervical discectomy, cervical disc herniation, minimally invasive surgery