Percutaneous Endoscopic Cervical Discectomy and Stabilization

Published on 10/03/2015 by admin

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Last modified 10/03/2015

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Chapter 23 Percutaneous Endoscopic Cervical Discectomy and Stabilization

Percutaneous endoscopic cervical discectomy (PECD) is a relatively new surgical method for treating soft cervical disc herniations [17]. The goal of the procedure is decompression of the spinal nerve root by percutaneous removal of the herniated mass under local anesthesia. A holmium:yttrium-aluminum-garnet (Ho:YAG) laser is generally used to ablate and shrink the herniated disc [17].

The WSH cervical endoscopy set (Karl Storz, Tuttlingen, Germany) consists of a high-resolution endoscope, illumination, and two irrigation channels [7]. The working channel allows passage of a side-firing Ho:YAG laser and microforceps. The excellent visualization via the endoscope permits the surgeon to selectively remove a portion of the herniated nucleus pulposus. After the anular anchorage has been loosened by the side-firing laser, the herniated fragment can be removed easily with the microforceps. With circumferential rotation of the working cannula and the endoscope, the side-firing laser can also ablate the thickened ligamentum flavum, remnant bone fragment, and shoulder osteophyte.

Although PECD is effective and can be an alternative to open anterior cervical discectomy and fusion, it has limitations. For example, it is ineffective in patients with segmental instability or cervical discogenic pain syndromes. However, the specially designed WSH Cervical B-Twin expandable holder (Disc-O-Tech Medical Technologies Ltd., Herzliya, Israel), which is made of titanium, can be used as an interbody spacer to achieve stability without open discectomy and fusion.

The major advantages of PECD and PECD stabilization (PECDS) with the B-Twin spacer are as follows [812]:

In cases of failure, this minimally invasive procedure does not preclude further conventional surgical approaches. It also offers numerous other advantages, such as the absence of risk of epidural bleeding and periradicular fibrosis, maintenance of stability of the intervertebral mobile segment, and reduced risk for recurrence after creating an anterior discal window. PECD or PECDS provides an excellent cosmetic effect, and the shorter operation time and hospital stay allow the patient to recover to normal daily activity more rapidly.