Anterior cervical discectomy and interbody fusion by endoscopic approach: a preliminary report

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Object

The authors report the short-term results of anterior cervical discectomy and interbody fusion performed via an endoscopic approach.

Methods

Thirty-six patients who underwent anterior cervical discectomy and fusion (ACDF) performed using endoscopic surgery were selected for this study. The indications for surgery were cervical disc herniation caused by neck injury, spondylotic myelopathy, cervical radiculopathy, and solitary ossification of the posterior longitudinal ligament (OPLL). The involved levels included C3–4, C4–5, C5–6, and C6–7. The working channel was inserted through a 20-mm transverse incision, the protruding discs or area of OPLL were excised for complete decompression, and then an appropriate intervertebral polyetheretherketone fusion cage was implanted.

Results

The time spent in surgery was 120 minutes on average (range 50–150 minutes), and the mean blood loss was 55 ml (range 20–140 ml). There were no intraoperative complications and no symptoms of irritation in the laryngopharynx after surgery. However, postoperative hemorrhage of the incision occurred in 1 case. The follow-up period ranged from 26–50 months (mean 38.5 months). Postoperative Japanese Orthopaedic Association and visual analog scale scores improved significantly.

Conclusions

Endoscopic surgery for ACDF can produce satisfactory results in patients with cervical disc herniation, cervical myelopathy, or radiculopathy. The optimal levels for this procedure are C4–5 and C5–6. Compared with a traditional approach, this technique has great advantages in terms of cosmetic results, intraoperative visualization, and postoperative recovery course. Nevertheless, every precaution should be taken to avoid possible complications, such as postoperative hemorrhage.

Abbreviations used in this paper:ACDF = anterior cervical discectomy and fusion; JOA = Japanese Orthopaedic Association; OPLL = ossification of the posterior longitudinal ligament; PEEK = polyetheretherketone; VAS = visual analog scale.

Article Information

Address correspondence to: Yanping Zheng, M.D., Department of Orthopedic Surgery, Qilu Hospital, Shandong University, 44 West Wenhua Road, Jinan, Shandong, China. email: zhengyanpingjn@163.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Intraoperative endoscopic views. A: View showing insertion of the working channel. Vertebrae are outlined in black. B: Endoscopic view after removal of intervertebral disc. C: View showing the fusion cage in place.

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    Preoperative and postoperative radiographs obtained in a patient who underwent ACDF. A: Preoperative radiograph showing the instability of L4–5 and decreased interbody space at L5–6. B: The instability and the height of the interbody space were improved at 3-month follow-up evaluation. C: Interbody fusion had been achieved at 1-year follow-up.

  • View in gallery

    Scatterplot showing the learning curve involved in performing endoscopic ACDF. The operating time was progressively reduced over the course of the 20 cases.

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