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 [1–7]. 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 [1–7].
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.
The major advantages of PECD and PECD stabilization (PECDS) with the B-Twin spacer are as follows [8–12]:
Indications and contraindications
The indication for PECD or PECDS (Box 23.1) is a soft cervical disc herniation that shows no response to conservative treatment for 6 weeks.
Preoperative preparation
The primary patient complaint is cervical radiculopathy or neck pain.
Imaging diagnosis consists of the following modalities and findings:
Instrumentation
Equipment
The following instruments and modalities are required in the operating room for PECD/PECDS:
Figure 23–1 A set of percutaneous endoscopic cervical discectomy (PECD) instruments. (Karl Storz, Germany)