Clinical Outcomes After Cervical Transcorporeal Microdecompression and Vertebral Body Access Channel Repair

A Novel Technique of Endoscopic Anterior Transcorporeal Approach with Channel Repair for Adjacent Segment Disease After Anterior Cervical Discectomy and Fusion

OBJECTIVE

To first report the application of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) with channel repair for a patient with adjacent segment disease (ASD) after anterior cervical discectomy and fusion.

METHODS

PEATCD with channel repair was performed for a patient with ASD at the cranial level adjacent to previous fusion at the C5-C6 level. The pre- and postoperative clinical symptoms were evaluated with Japanese Orthopedic Association and visual analog scale (VAS). The radiological examinations included magnetic resonance imaging, computed tomography, and plain radiographs, which were used to evaluate the cervical alignment, stability, intraoperative decompression, and bony channel.

RESULTS

The procedure was successfully completed within 70 minutes. The drainage tube was unnecessary. No surgery-related complications were recorded. The postoperative neck pain immediately improved to VAS 3 from preoperative VAS 6. The Japanese Orthopedic Association scores also took a turn for the better gradually from preoperative 10 to final 16 (improvement rate 85.7%). The muscle power recovered completely, and the Hoffman sign turned to negative during follow-up periods. Magnetic resonance imaging 1 week postoperatively showed a total removal of the herniation. The bony channel was almost disappeared on computed tomography images 3 months postoperatively. During postoperative periods, no relapse, channel collapse, bone plug migration, or instability was observed.

CONCLUSION

As a novel and supplemental procedure for ASD after anterior cervical discectomy and fusion, PEATCD combines the advantages of transcorporeal approach and endoscopy together, which decreases iatrogenic damage to disc, preserves the cervical motion segment, and reduces surgical trauma. As the limitations of 1 case show, the effectiveness and reliability of PEATCD for patients with ASD should be verified in further studies.

Outcomes and technical issues of transcorporeal anterior cervical microforaminotomy in patients with cervical brachialgia

INTRODUCTION

Transcorporeal anterior cervical microforaminotomy is a motion-preserving surgery. It addresses directly to the prolapsed disc in contrast to posterior laminoforaminotomy and does not affect facet joints; in the transuncal approach, there is a chance of vertebral artery injury and it also decreases disc height; hence, may alter the motion of that segment.

OBJECTIVE

Aim is to assess the outcome of surgery and its effectiveness.

METHODS

A total of 40 patients were observed retrospectively of which 33 were male and 7 were female. A single study of transcorporeal anterior cervical microforaminotomy was analyzed in a private hospital (Comfort Hospital), Dhaka, Bangladesh. Patients having pure brachialgia who were not relieved by conservative treatment over 6-8 weeks in cervical disc prolapse were included in the study. Patients having more than one level of disease, features of myelopathy, or instability were excluded from the study.

RESULTS

All patients were pain-free postoperatively, although after one to two months 2 out of 40 patients developed brachialgia and required anterior cervical discectomy and fusion.

CONCLUSION

Transcorporeal microforaminotomy for brachialgia is a safe and effective approach that is motion preserving and minimally invasive as well.

Transcorporeal Tunnel Approach for Cervical Radiculopathy and Myelopathy: A Systematic Review and Meta-Analysis

OBJECTIVE

The transcorporeal tunnel approach is a relatively new alternative of anterior cervical decompression and fusion for the treatment of cervical radiculopathy and myelopathy, with its main presumed advantage being the preservation of the intervertebral space. The aim of the present article is to present the outcomes of the systematic review and meta-analysis regarding the short-term outcomes of this surgical technique.

METHODS

A systematic review and a meta-analysis using the random-effects method of the available studies were performed to assess the safety and efficiency of the transcorporeal tunnel approach for cervical radiculopathy and myelopathy.

RESULTS

In total, 15 eligible studies were identified, with a cumulative number of 254 patients. Pooled data yielded a complication rate of 0.053 and a failure rate of the technique of 0.081; a patient-reported favorable outcome of 0.94 was documented. The available data did not allow for a definite conclusion on the effects of the technique on the intervertebral space height.

CONCLUSIONS

Although technically challenging, like all minimally invasive methods, the transcorporeal tunnel approach seems to be a safe and efficient option for the treatment of cervical radiculopathy and myelopathy, presenting comparable outcome profiles to alternative open or less invasive techniques.

Percutaneous Full-Endoscopic Anterior Transcorporeal Diskectomy for Massive Migrated Cervical Disk Herniation Treatment: Case Report and Review of the Literature

BACKGROUND

With the continuous advancement of the spinal endoscopic technique in recent years, full-endoscopic operations provide a new approach for the treatment of migrated cervical disk herniation.

CASE DESCRIPTION

A 42-year-old man presented with nuchal pain and limb numbness for 2 months, with recently developed symptoms of unstable walking. Physical examination revealed a diminished skin sensitivity to pain and temperature, beginning at the C4 dermatome. The muscle strength of both upper limbs decreased to grade 4, and the muscle strength was grade 4 on both sides of the lower limbs. Hoffmann sign and ankle clonus were positive. Magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated that a large piece of a segmental disk had migrated to the rear area of the C4 vertebral body and seriously compressed the spinal cord. A percutaneous full-endoscopic anterior transcorporeal cervical diskectomy was performed on the patient.

CONCLUSIONS

The postoperative Japanese Orthopaedic Association (JOA) score increased from 8 to 11 points. At 2-year follow-up, the JOA score was 16 points, the improvement rate was 88.9%, and cervical vertebrae MRI, cervical CT scan, and 3-dimensional reconstruction showed that the cervical vertebrae channel healed without vertebral fractures, bony channel collapse, adjacent segment degeneration, or intervertebral space height.

Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report

Background

Compared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH).

Methods

Four patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation.

Results

The average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative.

Conclusion

This is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure.

Trial registration

Numbers: ChiCTR1800016383. Registered 29 may 2018. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry.

Electronic supplementary material

The online version of this article (10.1186/s12891-019-2659-0) contains supplementary material, which is available to authorized users.