Asian Spine J.  2018 Apr;12(2):294-299. 10.4184/asj.2018.12.2.294.

Percutaneous Endoscopic Cervical Discectomy: Surgical Approaches and Postoperative Imaging Changes

Affiliations
  • 1Department of Orthopedic Surgery, Aichi Spine Institute, Niwa-gun, Aichi, Japan. nakamura@itoortho.or.jp

Abstract

STUDY DESIGN: Retrospective clinical study. PURPOSE: This study investigated the relationship between surgical approaches and surgical outcomes in patients undergoing percutaneous endoscopic cervical discectomy (PECD), including the reduction in intervertebral disc height and the incidence of Modic changes. OVERVIEW OF LITERATURE: The anterior approach involves partial invasion of the intervertebral disc, with a reported reduction in intervertebral disc height after PECD.
METHODS
Forty-two patients with cervical disk hernia who underwent PECD and magnetic resonance imaging at least 3 months postoperatively were divided into four groups according to the hernia sites and the surgical approach used: unilateral hernia treated using the contralateral approach (group C, n=18), unilateral hernia treated using the ipsilateral approach (group I, n=15), midline hernia (group M, n=4), and broad and bilateral hernia (group B, n=5). Modic changes and intervertebral disc height were evaluated.
RESULTS
The overall incidence of Modic changes was 52.4%: 72.2% in group C, 26.7% in group I, 25.0% in group M, and 80.0% in group B. The reduction in intervertebral disc height was 21.8% across all the patients: 24.5% in group C, 11.0% in group I, 22.8% in group M, and 23.9% in group B.
CONCLUSIONS
The incidence of Modic changes and the reduction in intervertebral disc height were lower in the patients treated using the ipsilateral approach than in those treated using the contralateral approach. Traditionally, a contralateral approach has been used for PECD; however, the ipsilateral approach is more appropriate and is therefore recommended.

Keyword

Intervertebral disc displacement; Magnetic resonance imaging; Endoscopes; Minimally invasive surgical procedures

MeSH Terms

Clinical Study
Diskectomy*
Endoscopes
Hernia
Humans
Incidence
Intervertebral Disc
Intervertebral Disc Displacement
Magnetic Resonance Imaging
Minimally Invasive Surgical Procedures
Retrospective Studies
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