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

Restricted access


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


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.


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.


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:

© AANS, except where prohibited by US copyright law.



  • View in gallery

    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.

  • View in gallery

    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.


  • 1

    Aldrich F: Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg 72:3703771990

    • Search Google Scholar
    • Export Citation
  • 2

    Burke TGCaputy A: Microendoscopic posterior cervical foraminotomy: a cadaveric model and clinical application for cervical radiculopathy. J Neurosurg 93:1 Suppl1261292000

    • Search Google Scholar
    • Export Citation
  • 3

    Cauthen JCKinard REVogler JBJackson DEDePaz OBHunter OL: Outcome analysis of noninstrumented anterior cervical discectomy and interbody fusion in 348 patients. Spine 23:1881921998

    • Search Google Scholar
    • Export Citation
  • 4

    Cho DYLee WYSheu PC: Treatment of multilevel cervical fusion with cages. Surg Neurol 62:3783862004

  • 5

    Cloward RB: The anterior approach for removal of ruptured cervical discs. J Neurosurg 15:6026171958

  • 6

    Flynn TB: Neurologic complications of anterior cervical interbody fusion. Spine 7:5365391982

  • 7

    Foley KTSmith MM: Microendoscopic discectomy. Tech Neurosurg 3:3013071997

  • 8

    Fontanella A: Endoscopic microsurgery in herniated cervical discs. Neurol Res 21:31381999

  • 9

    Hacker RJCauthen JCGilbert TJGriffith SL: A prospective randomized multicenter clinical evaluation of an anterior cervical fusion cage. Spine 25:264626552000

    • Search Google Scholar
    • Export Citation
  • 10

    Inamasu JGuiot BH: Vascular injury and complication in neurosurgical spine surgery. Acta Neurochir (Wien) 148:3753872006

  • 11

    Kao FCNiu CCChen LHLai PLChen WJ: Maintenance of interbody space in one- and two-level anterior cervical interbody fusion: comparison of the effectiveness of autograft, allograft, and cage. Clin Orthop Relat Res 430:1081162005

    • Search Google Scholar
    • Export Citation
  • 12

    Mastronardi LDucati AFerrante L: Anterior cervical fusion with polyetheretherketone (PEEK) cages in the treatment of degenerative disc disease. Preliminary observations in 36 consecutive cases with a minimum 12-month follow-up. Acta Neurochir (Wien) 148:3073122006

    • Search Google Scholar
    • Export Citation
  • 13

    Mathews HHEvans MTMolligan HJLong BH: Laparoscopic discectomy with anterior lumbar interbody fusion. A preliminary review. Spine 20:179718021995

    • Search Google Scholar
    • Export Citation
  • 14

    Miccoli PBerti PRaffaelli MMaterazzi GConte MFaldini A: Minimally invasive approach to the cervical spine: a proposal. J Laparoendosc Adv Surg Tech A 11:89922001

    • Search Google Scholar
    • Export Citation
  • 15

    Nowitzke AM: Assessment of the learning curve for lumbar microendoscopic discectomy. Neurosurgery 56:7557622005

  • 16

    Odom GLFinney WWoodhall B: Cervical disk lesions. J Am Med Assoc 166:23281958

  • 17

    Regan JJYuan HMcAfee PC: Laparoscopic fusion of the lumbar spine: minimally invasive spine surgery. A prospective multicenter study evaluating open and laparoscopic lumbar fusion. Spine 24:4024111999

    • Search Google Scholar
    • Export Citation
  • 18

    Roh SWKim DHCardoso ACFessler RG: Endoscopic foraminotomy using MED system in cadaveric specimens. Spine 25:2602642000

  • 19

    Rubino FDeutsch HPamoukian VZhu JFKing WAGagner M: Minimally invasive spine surgery: an animal model for endoscopic approach to the anterior cervical and upper thoracic spine. J Laparoendosc Adv Surg Tech A 10:3093132000

    • Search Google Scholar
    • Export Citation
  • 20

    Smith GWRobinson RA: The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 40:6076241958

    • Search Google Scholar
    • Export Citation
  • 21

    Tew JM JrMayfield FH: Complications of surgery of the anterior cervical spine. Clin Neurosurg 23:4244341976

  • 22

    Zdeblick TAPhillips FM: Interbody cage devices. Spine 28:SupplS2S72003




All Time Past Year Past 30 Days
Abstract Views 177 177 11
Full Text Views 108 105 0
PDF Downloads 127 107 0
EPUB Downloads 0 0 0


Google Scholar