Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YANG Junsong ¹ , CHU Lei ² ^# , DENG Zhongliang ² , Kai-Xuan Liu ³ , DENG Rui ² , CHEN Hao ¹ , LIU Peng ¹ , LIU Tuanjiang ¹ ,  RONG Xueqin ⁴ ,  HAO Dingjun ¹

1. Department of Spinal Surgery, Honghui Hospital Affiliated to Medical School of Xi’an Jiaotong University, Xi’an Shaanxi, 710054, P.R.China;
2. Department of Orthopedics, the Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, P.R.China;
3. Atlantic Spine Center, New Jersey, 07052, USA;
4. Pain Spine Minimally Invasive Center of Hainan Third People Hospital, Sanya Hainan, 572000, P.R.China;

Corresponding author：

RONG Xueqin, Email: 215069125@qq.com; HAO Dingjun, Email: dingjun.hao@qq.com

Keywords：

Cervical disc herniation; spinal endoscopy; transcorporeal approach; discectomy

DOI：

10.7507/1002-1892.201905118

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Objective To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach.Methods According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C_{3, 4} in 2 cases, C_{4, 5} in 8 cases, C_{5, 6} in 9 cases, and C_{6, 7} in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated.Results Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation (P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one (t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation (t=0.881, P=0.421).Conclusion Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results.

Citation： YANG Junsong, CHU Lei, DENG Zhongliang, Kai-Xuan Liu, DENG Rui, CHEN Hao, LIU Peng, LIU Tuanjiang, RONG Xueqin, HAO Dingjun. Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach. Chinese Journal of Reparative and Reconstructive Surgery, 2020, 34(5): 543-549. doi: 10.7507/1002-1892.201905118 Copy

1.	Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
2.	Ahn Y, Lee SH, Chung SE, et al. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. Neuroradiology, 2005, 47(12): 924-930.
3.	Ruetten S, Komp M, Merk H, et al. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2008, 33(9): 940-948.
4.	陈亮, 柯珍勇, 楚磊, 等. 前路经皮内窥镜下颈椎间盘髓核摘除术的临床应用. 中华创伤杂志, 2013, 29(7): 602-607.
5.	Tzaan WC. Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation: outcome, complications, and technique. J Spinal Disord Tech, 2011, 24(7): 421-431.
6.	Ruetten S, Komp M, Merk H, et al. Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop, 2009, 33(6): 1677-1682.
7.	Ahn Y, Lee SH, Shin SW. Percutaneous endoscopic cervical discectomy: clinical outcome and radiographic changes. Photomed Laser Surg, 2005, 23(4): 362-368.
8.	Yang JS, Chu L, Chen L, et al. Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation? A comparative cohort study. Spine (Phila Pa 1976), 2014, 39(21): 1743-1750.
9.	George B, Zerah M, Lot G, et al. Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal. Acta Neurochir (Wien), 1993, 121(3-4): 187-190.
10.	George B, Lot G, Mourier KL, et al. Cervical spondylosis. Resection by oblique transcorporeal approach. Neurochirurgie, 1993, 39(3): 171-177.
11.	Jho HD, Kim WK, Kim MH. Anterior microforaminotomy for treatment of cervical radiculopathy: part 1—disc-preserving “functional cervical disc surgery”. Neurosurgery, 2002, 51(5 Suppl): S46-S53.
12.	Choi G, Lee SH, Bhanot A, et al. Modified transcorporeal anterior cervical microforaminotomy for cervical radiculopathy: a technical note and early results. Eur Spine J, 2007, 16(9): 1387-1393.
13.	Hakuba A. Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg, 1976, 45(3): 284-291.
14.	Hakuba A, Komiyama M, Tsujimoto T, et al. Transuncodiscal approach to dumbbell tumours of the cervical spinal canal. J Neurosurg, 1984, 61: 1100-1106.
15.	Hong WJ, Kim WK, Park CW, et al. Comparison between transuncal approach and upper vertebral transcorporeal approach for unilateral cervical radiculopathy-a preliminary report. Minim Invasive Neurosurg, 2006, 49(5): 296-301.
16.	Choi KC, Ahn Y, Lee CD, et al. Combined anterior approach with transcorporeal herniotomy for a huge migrated cervical disc herniation. Korean J Spine, 2011, 8(4): 292-294.
17.	Choi G, Arbatti NJ, Modi HN, et al. Transcorporeal tunnel approach for unilateral cervical radiculopathy: a 2-year follow-up review and results. Minim Invasive Neurosurg, 2010, 53(3): 127-131.
18.	Kim JS, Eun SS, Prada N, et al. Modified transcorporeal anterior cervical microforaminotomy assisted by O-arm-based navigation: a technical case report. Eur Spine J, 2011, 20: S147-152.
19.	Shim CS, Jung TG, Lee SH. Transcorporeal approach for disc herniation at the C2-C3 level: a technical case report. J Spinal Disord Tech, 2009, 22(6): 459-462.
20.	陈亮, 肖福涛, 楚磊, 等. 经椎体入路经皮内镜下颈椎间盘髓核摘除术的可行性研究. 中华解剖与临床杂志, 2015, 20(1): 32-35.
21.	Deng ZL, Chu L, Chen L, et al. Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the C4-C5 levels: a technical note. Spine J, 2016, 16(5): 659-666.
22.	Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain, 1972, 95(1): 87-100.
23.	Yang JS, Chu L, Chen CM, et al. Foraminoplasty at the tip or base of the superior articular process for lateral recess stenosis in percutaneous endoscopic lumbar discectomy: A multicenter, retrospective, controlled study with 2-year follow-up. Biomed Res Int, 2018, 2018: 7692794.
24.	Yang JS, Chu L, Deng R, et al. Treatment of single-level thoracic tuberculosis by percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation: A multicenter study with a median follow-up of 36 months. World Neurosurg, 2019, 122: e1472-e1481.
25.	Chu L, Yang JS, Yu KX, et al. Percutaneous endoscopic retrieval of intraspinal cement leakage: technical note. World Neurosurg, 2018, 118: 150-155.
26.	Yu KX, Chu L, Chen L, et al. A novel posterior trench approach involving percutaneous endoscopic cervical discectomy for central cervical intervertebral disc herniation. Clin Spine Surg, 2019, 32(1): 10-17.
27.	于庆帅, 陈亮, 晏铮剑, 等. 经皮脊柱内镜治疗经皮椎体成形术后骨水泥椎管内渗漏的疗效观察. 中国修复重建外科杂志, 2017, 31(6): 690-695.
28.	李子全, 余可谊, 王以朋, 等. 经皮椎间孔入路脊柱内镜下单侧减压治疗腰椎管狭窄症临床疗效及非手术侧下肢症状观察研究. 中国修复重建外科杂志, 2019, 33(7): 831-836.
29.	Du Q, Wang X, Qin JP, et al. Percutaneous full-endoscopic anterior transcorporeal procedure for cervical disc herniation: A novel procedure and early follow-up study. World Neurosurg, 2018, 112: e23-e30.
30.	Wu WK, Yan ZJ, Zhang TF, et al. Biomechanical influences of transcorporeal tunnels on C4 vertebra under physical compressive load under flexion movement: A finite element analysis. World Neurosurg, 2018, 114: e199-e208.

1. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
2. Ahn Y, Lee SH, Chung SE, et al. Percutaneous endoscopic cervical discectomy for discogenic cervical headache due to soft disc herniation. Neuroradiology, 2005, 47(12): 924-930.
3. Ruetten S, Komp M, Merk H, et al. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine (Phila Pa 1976), 2008, 33(9): 940-948.
4. 陈亮, 柯珍勇, 楚磊, 等. 前路经皮内窥镜下颈椎间盘髓核摘除术的临床应用. 中华创伤杂志, 2013, 29(7): 602-607.
5. Tzaan WC. Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation: outcome, complications, and technique. J Spinal Disord Tech, 2011, 24(7): 421-431.
6. Ruetten S, Komp M, Merk H, et al. Full-endoscopic anterior decompression versus conventional anterior decompression and fusion in cervical disc herniations. Int Orthop, 2009, 33(6): 1677-1682.
7. Ahn Y, Lee SH, Shin SW. Percutaneous endoscopic cervical discectomy: clinical outcome and radiographic changes. Photomed Laser Surg, 2005, 23(4): 362-368.
8. Yang JS, Chu L, Chen L, et al. Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation? A comparative cohort study. Spine (Phila Pa 1976), 2014, 39(21): 1743-1750.
9. George B, Zerah M, Lot G, et al. Oblique transcorporeal approach to anteriorly located lesions in the cervical spinal canal. Acta Neurochir (Wien), 1993, 121(3-4): 187-190.
10. George B, Lot G, Mourier KL, et al. Cervical spondylosis. Resection by oblique transcorporeal approach. Neurochirurgie, 1993, 39(3): 171-177.
11. Jho HD, Kim WK, Kim MH. Anterior microforaminotomy for treatment of cervical radiculopathy: part 1—disc-preserving “functional cervical disc surgery”. Neurosurgery, 2002, 51(5 Suppl): S46-S53.
12. Choi G, Lee SH, Bhanot A, et al. Modified transcorporeal anterior cervical microforaminotomy for cervical radiculopathy: a technical note and early results. Eur Spine J, 2007, 16(9): 1387-1393.
13. Hakuba A. Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg, 1976, 45(3): 284-291.
14. Hakuba A, Komiyama M, Tsujimoto T, et al. Transuncodiscal approach to dumbbell tumours of the cervical spinal canal. J Neurosurg, 1984, 61: 1100-1106.
15. Hong WJ, Kim WK, Park CW, et al. Comparison between transuncal approach and upper vertebral transcorporeal approach for unilateral cervical radiculopathy-a preliminary report. Minim Invasive Neurosurg, 2006, 49(5): 296-301.
16. Choi KC, Ahn Y, Lee CD, et al. Combined anterior approach with transcorporeal herniotomy for a huge migrated cervical disc herniation. Korean J Spine, 2011, 8(4): 292-294.
17. Choi G, Arbatti NJ, Modi HN, et al. Transcorporeal tunnel approach for unilateral cervical radiculopathy: a 2-year follow-up review and results. Minim Invasive Neurosurg, 2010, 53(3): 127-131.
18. Kim JS, Eun SS, Prada N, et al. Modified transcorporeal anterior cervical microforaminotomy assisted by O-arm-based navigation: a technical case report. Eur Spine J, 2011, 20: S147-152.
19. Shim CS, Jung TG, Lee SH. Transcorporeal approach for disc herniation at the C2-C3 level: a technical case report. J Spinal Disord Tech, 2009, 22(6): 459-462.
20. 陈亮, 肖福涛, 楚磊, 等. 经椎体入路经皮内镜下颈椎间盘髓核摘除术的可行性研究. 中华解剖与临床杂志, 2015, 20(1): 32-35.
21. Deng ZL, Chu L, Chen L, et al. Anterior transcorporeal approach of percutaneous endoscopic cervical discectomy for disc herniation at the C4-C5 levels: a technical note. Spine J, 2016, 16(5): 659-666.
22. Nurick S. The pathogenesis of the spinal cord disorder associated with cervical spondylosis. Brain, 1972, 95(1): 87-100.
23. Yang JS, Chu L, Chen CM, et al. Foraminoplasty at the tip or base of the superior articular process for lateral recess stenosis in percutaneous endoscopic lumbar discectomy: A multicenter, retrospective, controlled study with 2-year follow-up. Biomed Res Int, 2018, 2018: 7692794.
24. Yang JS, Chu L, Deng R, et al. Treatment of single-level thoracic tuberculosis by percutaneous endoscopic débridement and allograft via the transforaminal approach combined with percutaneous pedicle screw fixation: A multicenter study with a median follow-up of 36 months. World Neurosurg, 2019, 122: e1472-e1481.
25. Chu L, Yang JS, Yu KX, et al. Percutaneous endoscopic retrieval of intraspinal cement leakage: technical note. World Neurosurg, 2018, 118: 150-155.
26. Yu KX, Chu L, Chen L, et al. A novel posterior trench approach involving percutaneous endoscopic cervical discectomy for central cervical intervertebral disc herniation. Clin Spine Surg, 2019, 32(1): 10-17.
27. 于庆帅, 陈亮, 晏铮剑, 等. 经皮脊柱内镜治疗经皮椎体成形术后骨水泥椎管内渗漏的疗效观察. 中国修复重建外科杂志, 2017, 31(6): 690-695.
28. 李子全, 余可谊, 王以朋, 等. 经皮椎间孔入路脊柱内镜下单侧减压治疗腰椎管狭窄症临床疗效及非手术侧下肢症状观察研究. 中国修复重建外科杂志, 2019, 33(7): 831-836.
29. Du Q, Wang X, Qin JP, et al. Percutaneous full-endoscopic anterior transcorporeal procedure for cervical disc herniation: A novel procedure and early follow-up study. World Neurosurg, 2018, 112: e23-e30.
30. Wu WK, Yan ZJ, Zhang TF, et al. Biomechanical influences of transcorporeal tunnels on C4 vertebra under physical compressive load under flexion movement: A finite element analysis. World Neurosurg, 2018, 114: e199-e208.

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Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach

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