KENDOSCOPIC CERVICAL DISCECTOMY

KEYHOLE SURGERY FOR CERVICAL DISC HERNIATIONS

WHAT IS ENDOSCOPIC CERVICAL DISCECTOMY?

Endoscopic cervical discectomy is one of the treatment methods for cervical herniations that can cause pain in the arm and shoulder region. There are two different techniques for this surgery. In the first technique, the disc is entered from the front and the hernia is reached through the disc. In the second technique, the disc is entered from the back and the herniated tissue is accessed from under the nerve. Both techniques work well to preserve most of the disc and have fewer potential complications, especially compared to traditional open surgery which requires a skin incision and the disc to be completely taken out.

ABOUT THE PROCEDURE

The anterior approach is performed under local anesthesia by inserting a 0.4 cm cannula, similar to a lumbar cannula, but thinner, along with an endoscope into the disc with the help of a scope. Bipolar radiofrequency (RF) and endoscopic instruments are used in this procedure so that the nerve root can be seen and only the herniated part of the disc can be removed.

The anterior approach was the first endoscopic technique used, but with the advancements in technology and surgical techniques, the posterior approach is now being used more frequently. In this approach, 2 different techniques can be used, either the monoportal and biportal technique. In the monoportal technique, the cannula is inserted through the tissue expanders without cutting the tissues themselves with the help of the operating room x-ray (fluoroscopy). The camera system, i.e. the endoscope and the hand tools used in the procedure are passed through the cannula. Since the nerve roots in the area can be seen directly, they can be protected while the hernia is being removed from under the nerve. In the biportal technique (UBE surgery), similar to the monoportal technique, a camera is inserted through a small 5 mm long hole at the appropriate point. Surgical instruments are then advanced through the second 7 mm hole to reach the herniated disc and remove the herniated disc material.

WHEN CAN ENDOSCOPIC CERVICAL DISCECTOMY BE APPLIED?

The main indication for this procedure is soft cervical disc herniations that do not benefit from physical therapy and other conservative treatment methods. It is not performed in patients with severe spinal cord compression and myelopathy findings. In these patients, other endoscopic methods can be applied.

A soft cervical disc herniation is a classic cervical herniated disc in which the disc ruptures and the jelly-like nucleus pulposus herniates and compresses the spinal cord or nerve root. Since the nucleus pulposus usually compresses backwards and outwards, pain in the arms is the most common symptom. Often pain can also occur around the shoulder blade. If the patient is not treated and the pressure on the nerve is not removed, the muscles in the arms and hands gradually weaken, reflexes as well as sensory nerve fibers are also impaired. In severe cases, patients may even become unable to walk.

WHAT ARE THE ADVANTAGES OF ENDOSCOPIC CERVICAL DISCECTOMY?

  • It does not cause epidural bleeding or adhesions around the nerves.
  • Since most of the disc tissue is preserved, a metallic cage plate or prosthesis is not required.
  • Instability of the spine extremely rare.
  • Recurrence of a hernia is extremely rare as this procedure is performed by opening a small canal.
  • There is a fast recovery as the procedure is quick and the hospital stay is very short.
  • Patients can be discharged from the hospital on the same day as their surgery and be able to return to their daily lives in a short time.

WHAT ARE THE POSSIBLE COMPLICATIONS?

Although very rare, there may be complications during this surgery. A surgeon experienced in endoscopic surgical techniques is essential in lowering the risk of complication in these surgeries and studies suggest that complication rates of endoscopic cervical discectomy are much lower than with open surgery. Nerve injury, a burning sensation and numbness in the arm, dural tears, bleeding and spinal instability are potential complications and sometimes may require additional treatment. Regardless of the surgical method used, some scar tissue is always formed in the surgical area. Although scar tissue formation is much less in endoscopic spine surgery compared to other surgical methods, it is still possible.