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Basic principle of percutaneous endoscopic cervical discectomy (PECD). A. Anterior percutaneous cervical approach. The trachea is pushed medially by finger pressure, keeping the carotid sheath laterally. B. Sequential dilation technique from the needle approach to the final working sheath via the safe working zone was conducted. C. Release of the annular anchorage using the side-firing laser or radiofrequency dissector. D. Selective cervical discectomy is performed under direct endoscopic visualization, preserving the central nucleus.
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Percutaneous endoscopic cervical discectomy (PECD) is an effective minimally invasive surgery for soft cervical disc herniation in properly selected cases. The current gold standard is anterior cervical discectomy and fusion (ACDF). However, few studies have evaluated the outcome of PECD compared with ACDF. We compared the surgical results of PECD...
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Citations
... Ahn et al. reported 5-year follow-up outcomes of anterior full endoscopic discectomy for soft disc herniation and showed comparable results with conventional ACDF [95]. Recently, endoscopic ACDF has also been performed, but no concrete data are currently available to prove its efficacy (Table 4). ...
... Recently, endoscopic ACDF has also been performed, but no concrete data are currently available to prove its efficacy (Table 4). (Figure 6) Ahn et al. reported 5-year follow-up outcomes of anterior full endoscopic discectomy for soft disc herniation and showed comparable results with conventional ACDF [95]. Recently, endoscopic ACDF has also been performed, but no concrete data are currently available to prove its efficacy (Table 4). ...
Background: The aging of the population in developing and developed countries has led to a significant increase in the health burden of spinal diseases. These elderly patients often have a number of medical comorbidities due to aging. The need for minimally invasive techniques to address spinal disorders in this elderly population group cannot be stressed enough. Minimally invasive spine surgery (MISS) has several proven benefits, such as minimal muscle trauma, minimal bony resection, lesser postoperative pain, decreased infection rate, and shorter hospital stay. Methods: A comprehensive search of the literature was performed using PubMed. Results: Over the past 40 years, constant efforts have been made to develop newer techniques of spine surgery. Endoscopic spine surgery is one such subset of MISS, which has all the benefits of modern MISS. Endoscopic spine surgery was initially limited only to the treatment of lumbar disc herniation. With improvements in optics, endoscopes, endoscopic drills and shavers, and irrigation pumps, there has been a paradigm shift. Endoscopic spine surgery can now be performed with high magnification, thus allowing its application not only to lumbar spinal stenosis but also to spinal fusion surgeries and cervical and thoracic pathology as well. There has been increasing evidence in support of these newer techniques of spine surgery. Conclusions: For this report, we studied the currently available literature and outlined the historical evolution of endoscopic spine surgery, the various endoscopic systems and techniques available, and the current applications of endoscopic techniques as an alternative to traditional spinal surgery.
... The complication rate of the anterior cervical endoscopic approach was found to be comparable to that of ACDF, with dysphagia being the most common complication. Ahn et al. [53] compared outcomes between 51 patients undergoing endoscopic discectomy and 64 patients undergoing ACDF for single-level soft cervical disc herniation. Three patients in the ACDF group and one in the endoscopic group experienced transient swallowing difficulties. ...
... The applicability of cervical endoscopic spine surgery is somewhat confined, with the strongest evidence supporting its use in cases involving soft cervical herniated discs and cervical radiculopathy caused by focal compression [37,44,53,64]. Although there have been a few reports of patients undergoing two-level cervical endoscopic unilateral laminotomy for bilateral decompression in cases of cervical spondylotic myelopathy [31,58], the limited visual field and small working channel inherent to the endoscopic approach can lead to less efficient decompression procedures. ...
Cervical endoscopic spine surgery is rapidly evolving and gaining popularity for the treatment of cervical radiculopathy and myelopathy. This approach significantly reduces muscular damage and blood loss by minimizing soft tissue stripping, leading to less postoperative pain and a faster postoperative recovery. As scientific evidence accumulates, the efficacy and safety of cervical endoscopic spine surgery are continually affirmed. Both anterior and posterior endoscopic approaches have surfaced as viable alternative treatments for various cervical spine pathologies. Newer techniques, such as endoscopic-assisted fusion, the anterior transcorporeal approach, and unilateral laminotomy for bilateral decompression, have been developed to enhance clinical outcomes and broaden surgical indications. Despite its advantages, this approach faces challenges, including a steep learning curve, increased radiation exposure for both surgeons and patients, and a relative limitation in addressing multi-level pathologies. However, the future of cervical endoscopic spine surgery is promising, with potential enhancements in clinical outcomes and safety on the horizon. This progress is fueled by integrating advanced imaging and navigation technologies, applying regional anesthesia for improved and facilitated postoperative recovery, and incorporating cutting-edge technologies, such as augmented reality. With these advancements, cervical endoscopic spine surgery is poised to broaden its scope in treating cervical spine pathologies while maintaining the benefits of minimized tissue damage and rapid recovery.
... Patient clinical pain was assessed using Visual Analog Scale of Arms (A-VAS) and Neck (N-VAS), and cervical spine dysfunction was assessed using Japanese [13,14]. At the last follow-up, patient satisfaction with the procedure was assessed using the modified MacNab criteria [15]. ...
... In recent years, with continuous innovation and refinement of minimally invasive endoscopic techniques, spinal endoscopy applied to lumbar degenerative diseases has matured, and has recently been gradually transitioning to the treatment of cervical degenerative diseases. Several studies have shown that minimally invasive endoscopic techniques in the cervical spine could be applied to treat CSS with good clinical outcomes [10,15]. In a proof-of-concept in vitro trial, Eicker et al. [27] performed full-endoscopic arcocristectomy on 55 segments of cervical stenosis in 10 cadaveric specimens, resulting in an average increase of 4.1 mm (± 1.2 mm) in the sagittal diameter of the cervical canal postoperatively. ...
Objective
Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy decompression or ACDF.
Methods
138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG).
Results
After PSM, 84 patients were included in the study and followed for 24–30 months. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P < 0.001). Postoperative N-VAS, A-VAS, JOA, and NDI were significantly improved in both groups compared with the preoperative period (P < 0.001), and the endoscopic group showed better improvement at 7 days postoperatively (P < 0.05). The ROM changes of adjacent segments were significantly larger in the ACDF group at 12 months postoperatively and at the last follow-up (P < 0.05). The RVG of adjacent segments showed a decreasing trend, and the decrease was more marked in the ACDF group at last follow-up (P < 0.05). According to the modified MacNab criteria, the excellent and good rates in the endoscopic group and ACDF group were 90.48% and 88.10%, respectively, with no statistically significant difference (P > 0.05).
Conclusion
Full endoscopic laminotomy decompression is demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration.
... Power analysis was conducted using a priori sample size calculator for the Wilcoxon-Mann-Whitney test. To reach a power of 95%, a sample size of 156 patients in each group was calculated, with an alpha level of 0.05 and an effect size of 0.42 derived from previously published data [19]. ...
Background: We aimed to analyze the clinical outcomes and effectiveness of cervical biportal endoscopic spine surgery (C-BESS) and anterior cervical discectomy and fusion (ACDF) in patients with symptomatic cervical disc herniation. Methods: This study was a retrospective chart review of four-year clinical data involving 318 cases of symptomatic cervical disc herniation, with 156 patients undergoing the ACDF and 162 patients receiving the C-BESS. Preoperative and postoperative one-year data were collected. Results: The numeric rating scale and neck disability index showed statistically significant improvement for both ACDF and C-BESS groups. While showing a longer operation time and more blood loss during surgery compared to the ACDF group, the C-BESS group demonstrated a learning effect as the surgeon’s proficiency increased with more cases. There was no significant difference in the postoperative length of hospitalization between the two methods. The subgroup with predominant arm pain revealed the statistical difference in arm pain intensity changes between the two groups (p < 0.001). The rates of complication were 2.6% for the ACDF group and 1.9% for the C-BESS group. Conclusions: C-BESS and ACDF are effective surgical treatments for patients with symptomatic single-level cervical disc herniation in relieving relevant pain intensities and pain-related disabilities.
... Full endoscopic anterior cervical discectomy without fusion in select patients with soft disc herniations, unilateral radiculopathy, and central disc herniations has demonstrated good clinical outcomes [28]. This has been shown to have comparable results with conventional ACDF surgery after a 5-year follow up [29]. ...
The purpose of this paper is to review the data supporting current endoscopic surgical techniques for the spine and the potential challenges and future of the field. The origins of endoscopic spine surgery can be traced back many decades, with many important innovations throughout its development. It can be applied to all levels of the spine, with many robust trials supporting its clinical outcomes. Continued clinical research is needed to explore its expanding indications. Although the limitations of starting an endoscopic program can be justified by its cost effectiveness and positive societal impact, challenges facing its widespread adoption are still present. As more residency and fellowship programs include endoscopy as part of their spine training, it will become more prevalent in hospitals in the United States. Technological advancements in spine surgery will further propel and enhance endoscopic techniques as they become an integral part of a spine surgeon’s repertoire.
... MCID value changes of ≥2.6, ≥4.1, ≥2.5, and ≥17.3% were used for N-VAS, A-VAS, JOA, and NDI, respectively [13,14] . At the last followup, patient satisfaction with the procedure was assessed using the modi ed MacNab criteria [15] . ...
... In recent years, with continuous innovation and re nement of minimally invasive endoscopic techniques, spinal endoscopy applied to lumbar degenerative diseases has matured, and has recently been gradually transitioning to the treatment of cervical degenerative diseases. Several studies have shown that minimally invasive endoscopic techniques in the cervical spine could be applied to treat CSS with good clinical outcomes [10,15] . In a proof-of-concept in vitro trial, Eicker et al. [23] performed full-endoscopic arcocristectomy on 55 segments of cervical stenosis in 10 cadaveric specimens, resulting in an average increase of 4.1 mm (± 1.2 mm) in the sagittal diameter of the cervical canal postoperatively. ...
Objective
Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy decompression or ACDF.
Methods
138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG).
Results
After PSM, 84 patients were included in the study. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P < 0.001). Postoperative N-VAS, A-VAS, JOA, and NDI were significantly improved in both groups compared with the preoperative period (P < 0.001), and the endoscopic group showed better improvement at 7 days postoperatively (P < 0.05). The ROM changes of adjacent segments were significantly larger in the ACDF group at 12 months postoperatively and at the last follow-up (P < 0.05). The RVG of adjacent segments showed a decreasing trend, and the decrease was more marked in the ACDF group at last follow-up (P < 0.05). According to the modified MacNab criteria, the excellent and good rates in the endoscopic group and ACDF group were 90.48% and 88.10%, respectively, with no statistically significant difference (P > 0.05).
Conclusion
Full endoscopic laminotomy decompression was demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration.
... Although surgical treatment via anterior discectomy and fusion (ACDF) is still a good possibility in the treatment of cervical disc herniations [2,19,20], this technique carries many risks such as pseudoarthrosis, infection, persistent pain, adjacent segment disease, and some complications associated with the approach such as dysphagia, vascular damage, and dysphonia, which sometimes cannot be avoided [2,21,22]. For this reason, some alternative procedures have been developed, such as microendoscopic, endoscopic-assisted, and full-endoscopic posterior foraminotomy [2,23]. ...
Endoscopic surgery of the cervical spine is constantly evolving and the spectrum of its indications has expanded in recent decades. Full-endoscopic techniques have standardized the procedures for posterior and anterior access. The full-endoscopic approach was developed to treat degenerative diseases with the least possible invasion and without causing instability of the cervical spine. The posterior full-endoscopic approach is indicated for the treatment of diseases of the lateral part of the vertebral segment, such as herniations and stenoses of the lateral recess and vertebral foramen. There has been little discussion of this approach to the treatment of central stenosis of the cervical spine. This technical note describes a step-by-step surgical technique for central and over-the-top full-endoscopic decompression in the cervical spine, using a 3.7 mm working channel endoscope. This technique has already been shown to be effective in a recent case series with a 4.7 mm working channel endoscope, and may represent a new treatment option for central or bilateral lateral recess stenosis. There is also the possibility of a bilateral full-endoscopic approach, but this may be associated with greater muscle damage and a longer operative time. Case series and comparative studies should be encouraged to confirm the safety and utility of this technique.
... The gold standard for conservative treatment-resistant cervical spondylotic radiculopathy (CSR) is anterior cervical discectomy and fusion (ACDF). However, for single-segment CSR, non-fusion decompression surgery is commonly used to avoid adjacent segment degeneration and reduce the inefficiency associated with fusion [1][2][3][4][5]. Non-fusion decompression techniques can be performed through anterior or posterior approaches, each with its own advantages [6,7]. ...
... Non-fusion decompression techniques can be performed through anterior or posterior approaches, each with its own advantages [6,7]. Among these, the posterior approach, specifically minimally invasive posterior cervical foraminotomy (MIS-PCF), has been shown to achieve more adequate decompression of the nerve root canal [3,8], making it a popular choice for its effectiveness [9,10]. ...
The search for more effective and safe treatment methods for cervical spondylotic radiculopathy (CSR) has led to the rapid development and increasing popularity of minimally invasive posterior cervical foraminotomy (MI-PCF). This study aims to compare two important approaches for MI-PCF surgery: the channel-assisted cervical key hole technology combined with ultrasonic bone osteotome (CKH-UBO) and posterior percutaneous endoscopic cervical foraminotomy (PPECF).
Data from patients treated with single-level CKH-UBO (n = 35) or PPECF (n = 40) were analyzed. Clinical outcomes, including visual analogue scale (VAS) scores for neck and arm pain, Neck Disability Index (NDI), and modified Macnab criteria, were assessed preoperatively, as well as at three days, three months, and one year postoperatively.
The percentages of patients with excellent and good outcomes were 97.14% and 92.5%, respectively. The average surgical time in the CKH-UBO group was significantly shorter than in the PPECF group (p < 0.001), while the average incision length in the PPECF group was significantly smaller than in the CKH-UBO group. There were no significant differences between the two groups in terms of blood loss, hospital stay, and clinical outcomes at three days, three months, and 12 months postoperatively.
CKH-UBO can achieve the same surgical outcomes as PPECF for the treatment of CSR. However, CKH-UBO saves more time but requires patients to undergo larger incisions.
... ACDF have been the gold standard of cervical disc operation, but fusion of vertebrae may cause development of adjacent disc disease and may need further surgical intervention [7]. Besides, the endoscopic approach can decompress the neural structure and preserve the mobility simultaneously [8]. With development of endoscopic equipment and surgical technique, it has been ap- ...
The advent of endoscopic technology has facilitated the evolution of endoscopic techniques and broadened the indications of fully endoscopic spine surgery. Endoscopic cervical spinal surgery is currently effective for treating herniated intervertebral discs, foraminal stenosis, and central canal stenosis. Although growing evidence has revealed the safety and advantages of endoscopic approaches, fully endoscopic spine surgical procedures remain challenging and have a steep learning curve, especially in the cervical spine. The anatomical features and pathologic patterns of the cervical spine also affect the application of endoscopic approaches. In this review, the authors introduce the successful points of fully endoscopic cervical spine surgery.
... the anterior approach carries the risk of revision surgery and requires an extension of fusion levels [3]. Posterior endoscopic cervical foraminotomy (PECF) is an alternative strategy for cervical radiculopathy that was first used in 2000 [4,5]. PECF provides similar outcomes as ACDF. ...
... Evidence supporting PECF as an alternative to ACDF in cervical radiculopathy is increasing [6]. PECF offers similar outcomes to ACDF in selected cases with fewer complications and shorter hospital stays [4,10]. The direct cost of PECF is 89% on average, less than that of ACDF [11]. ...
Objective: Anterior cervical discectomy and fusion (ACDF) surgery is a standard treatment for cervical spondylotic myelopathy or radiculopathy. Although the outcomes of ACDF are quite satisfactory, recurrent radiculopathy due to restenosis or adjacent degeneration cannot be completely avoided. We applied posterior endoscopic cervical foraminotomy (PECF) as salvage surgery after ACDF in 11 patients (16 levels). Methods: We performed PECF in 11 patients (16 levels) in the past 5 years for recurrent radiculopathy after ACDF. The time until the development of recurrent radiculopathy ranged from 8 months to 3 years. Before surgery, all patients were treated with adequate medication and rehabilitation. The radiological tools used for the evaluation included x-ray examinations (with anteroposterior, lateral, flexion, extension, and bilateral oblique views), computed tomography, and magnetic resonance imaging of the cervical spine.Results: Only one of the 11 patients did not respond immediately; however, that patient showed gradual recovery after decompression surgery in the following 6 months. Another patient showed good sensory function recovery, but transient motor palsy for 2 weeks. Otherwise, all the other patients showed motor or sensory function recovery, without symptom deterioration. None of these patients presented instability or mechanical pain after surgery or required repeat anterior surgery during follow-up (8 to 20 months; mean, 12 months).Conclusion: PECF, a minimally invasive posterior cervical surgical procedure, is efficient and effective as salvage surgery for restenosis after ACDF. This procedure prevents scarring along the trajectory and the need for longer fusion.
