J Korean Med Sci.  2009 Apr;24(2):302-306. 10.3346/jkms.2009.24.2.302.

Early Outcome of Posterior Cervical Endoscopic Discectomy: An Alternative Treatment Choice for Physically/Socially Active Patients

• Kim CH
• Chung CK
• Kim HJ
• Jahng TA
• Kim DG

• KMID: 1779134
• DOI: http://doi.org/10.3346/jkms.2009.24.2.302

Abstract

Anterior cervical discectomy and fusion (ACDF) is currently the standard treatment for cervical disc disease. Some patients wish to be treated with a less invasive method, because of their social/physical situations. Here we present one method of treatments for socially/physically active patients. Three patients had triceps weakness and mild posterior neck pain. The offending lesions were at the C6-7 level. All were middle-aged soldiers with families. If conventional ACDF were performed, they would have to retire from the military according to the regulation. They had to be able to perform military drills after the treatment if they were going to be able to keep their jobs. Because of their social/physical situations, all wanted to choose method with that they could treat the disease and keep their jobs. For these reasons, the posterior cervical endoscopic discectomies were performed. Ruptured fragments were successfully removed in all. The arm pain improved by more than 90% in two patients by 7 days and in the other patient by 2 months, respectively (excellent outcome by Macnab's criteria). None of the operations caused instability. All of the patients are currently able to successfully perform their military drills without difficulty. The posterior cervical endoscopic discectomy may be a promising alternative for the physically/socially active patients.

Keyword

Endoscopes; Cervical; Diskectomy; Posterior

MeSH Terms

Adult
Cervical Vertebrae/radiography/*surgery
*Diskectomy
Endoscopy
Humans
Intervertebral Disk/radiography/surgery
Magnetic Resonance Imaging
Male
Severity of Illness Index
Tomography, X-Ray Computed
Treatment Outcome

Figure

• 

  Fig. 1 (A) Left: T2-weighted sagittal MR image shows disc degeneration at the C5-6 and 6-7 levels. Middle and right: disc protrusion was noted on the right side of the foramen, which compressed the C7 root (arrow). (B) Left and right: Postoperative T2-weighted sagittal MR image shows good removal of the compressive lesion and root decompression. Note the signal change along the trajectory of operation (arrow). (C) Postoperative axial computed tomography shows that the right side of the lamina was partially removed with facet joint preservation. (D) Preoperative dynamic view of the cervical spine shows no instability. (E) Stability and height of C6-7 are preserved after operation.

• 

  Fig. 2 (A) T2-weighted axial MR image shows a ruptured disc on the left side of the C6-7 disc space. This lesion compresses both the spinal cord and root. (B) MR images taken one week after the operation shows that most of the ruptured disc was removed. The capsule around the herniated nucleus remained (black line), and it appeared to compress the root. (C) MR image obtained two months after the operation shows slight shrinkage of the remaining capsule and a reduction in the amount of compression.

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