Cervical endoscopy using transcorporeal route

Abstract

Backgrounds: The most common treatment options for foraminal disc herniation and the resulting cervical spondylotic radiculopathy (CSR) are anterior cervical discectomy and fusion (ACDF), or laminoforaminotomy, which is accomplished posteriorly. However, these procedures are not without limitations or complications. In this regard, several reports have focused on the decompression of a cervical disc herniation or stenosis impinging on the cervical nerve root near or exiting the cervical intervertebral foramen through the vertebral transcorporeal route. However, their outcomes after these anterior cervical discectomy without fusion vary among the institutes. Methods: After careful selection of the patients with isolated cervical soft disc herniation or focal osteophyte formation without instability, subluxation, malalignment, or loss of normal cervical lordosis, the number of the patients that required a delayed fusion procedure could be reduced to less than 1.5%. With these promising results from the literature, the authors have pursued direct removal of disc space pathology through transcorporeal route from the subjects that have met those selection criteria, leaving the majority of the anterior and central disc, anterior longitudinal ligament, and both upper and lower vertebral end plates intact. Results: The crucial steps for this procedure include: 1. Direct decompression of the offending compressive pathology as compared to an indirect decompression through the posterior approach 2. Preservation of the cervical motion segment by avoiding violation of the facet joints 3. Contained or limited end plate disruption in reaching the herniation Conclusions: This selective removal procedure might exclude the fusion surgery-related complications while deterring the development of subsequent instability. Moreover, since it includes an “oblique” drilling procedure, this might also give a more free access to the region such as high cervical or cervicothoracic junction.