Posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

YU Qingshuai , DENG Rui , SHI Lei , CHU Lei , CHENG Yun , YAN Zhengjian , KE Zhenyong ,  DENG Zhongliang

Department of Orthopedics-Spine Surgery Center, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, 400010, P.R.China;

Corresponding author：

DENG Zhongliang, Email: zhongliang.deng@qq.com

Keywords：

Percutaneous endoscopy; vertical anchor technique; trench technique; central cervical disc herniation

DOI：

10.7507/1002-1892.202101011

Video：

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Objective To investigate the clinical feasibility, safety, and effectiveness of posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation.Methods Between July 2017 and August 2019, 13 patients with the single-segmental central cervical disc herniation suffering from various neurologic deficits were treated with posterior percutaneous endoscopy via vertical anchor technique combined with trench technique. There were 6 males and 7 females with an average age of 50.5 years (range, 43-64 years). Disease duration ranged from 3 to 17 months (mean, 9.2 months). The clinical symptoms of 5 cases were mainly neck pain, radiculopathy, and numbness in upper limbs, and the visual analogue scale (VAS) score was 6.60±0.55. The clinical symptoms of 8 cases were myelopathy including upper extremities numbness, weakness, and trouble walking, and the modified Japanese Orthopedic Association (mJOA) score was 12.75±0.71. The surgery-related complications, operation time, and intraoperative blood loss were recorded, and the results of clinical symptoms were measured by VAS scores and mJOA scores.Results All procedures were completed successfully, no severe complications such as dural tears or cerebrospinal fluid leakage occurred. The operation time ranged from 83 to 164 minutes (mean, 101.2 minutes). The intraoperative blood loss was 25-50 mL (mean, 33.1 mL). After operation, 12 of 13 cases were followed up 10-24 months (mean, 17.6 months). The VAS scores of patients with preoperative pain symptoms were 2.40±0.55 on the first day after operation and 1.80±0.45 at last follow-up, which were significantly lower than those before operation (P<0.05). The mJOA scores of patients with the symptoms of spinal cord injury were 12.63±0.52 on the first day after operation and 14.29±0.95 at last follow-up, and the score at last follow-up was significantly higher than that before operation (P<0.05). Acute extremities weakness occurred for the postoperative hematoma formation in 1 case (disc herniation at C_{4, 5}) presented with myelopathy preoperatively, and muscle strength was recovered after the clearance of hematoma and spinal cord decompression under percutaneous endoscopy.Conclusion Posterior percutaneous endoscopy via vertical anchor technique and trench technique for single-segmental central cervical disc herniation was clinical feasible, safe, and effective, and could be an alternative approach to the treatment of central cervical disc herniation.

Citation： YU Qingshuai, DENG Rui, SHI Lei, CHU Lei, CHENG Yun, YAN Zhengjian, KE Zhenyong, DENG Zhongliang. Posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation. Chinese Journal of Reparative and Reconstructive Surgery, 2021, 35(5): 579-585. doi: 10.7507/1002-1892.202101011 Copy

1.	Clausen JD, Goel VK, Traynelis VC, et al. Uncinate processes and Luschka joints influence the biomechanics of the cervical spine: quantification using a finite element model of the C₅-C₆ segment. J Orthop Res, 1997, 15(3): 342-347.
2.	Choi KY, Eun SS, Lee SH, et al. Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg, 2010, 53(1): 25-28.
3.	Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
4.	Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143: 90-94.
5.	Liao C, Ren Q, Chu L, et al. Modified posterior percutaneous endoscopic cervical discectomy for lateral cervical disc herniation: the vertical anchoring technique. Eur Spine J, 2018, 27(6): 1460-1468.
6.	Liu C, Liu K, Chu L, et al. Posterior percutaneous endoscopic cervical discectomy through lamina-hole approach for cervical intervertebral disc herniation. Int J Neurosci, 2019, 129(7): 627-634.
7.	Yu KX, Chu L, Yang JS, et al. Anterior transcorporeal approach to percutaneous endoscopic cervical diskectomy for single-level cervical intervertebral disk herniation: case series with 2-year follow-up. World Neurosurg, 2019, 122: e1345-e1353.
8.	杨俊松, 楚磊, 邓忠良, 等. 前路经椎体内入路全内镜下减压治疗单节段颈椎间盘突出症临床研究. 中国修复重建外科杂志, 2020, 34(5): 543-549.
9.	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.
10.	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.
11.	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.
12.	Ren Y, Yang J, Chen CM, et al. Outcomes of discectomy by using full-endoscopic visualization technique via the transcorporeal and transdiscal approaches in the treatment of cervical intervertebral disc herniation: a comparative study. Biomed Res Int, 2020, 2020: 5613459. doi: 10.1097/MD.0000000000013456.
13.	Kim CH, Shin KH, Chung CK, et al. Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical diskectomy. Global Spine J, 2015, 5(1): 31-38.
14.	邓忠良. 从机体内环境稳态理解微创脊柱外科手术的内涵与原则. 中华创伤杂志, 2015, 31(10): 865-867.
15.	邓忠良. 经皮脊柱内镜手术的相关问题. 中国骨伤, 2020, 33(5): 393-396.
16.	Wu W, Yan Z. Intraoperative total spinal anesthesia as a complication of posterior percutaneous endoscopic cervical discectomy. Eur Spine J, 2018, 27(Suppl 3): 431-435.
17.	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.
18.	Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11: 605-616.
19.	Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143: 90-94.
20.	Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech, 2009, 22(2): 122-129.
21.	Chu L, Yang JS, Yu KX, et al. Usage of bone wax to facilitate percutaneous endoscopic cervical discectomy via anterior transcorporeal approach for cervical intervertebral disc herniation. World Neurosurg, 2018, 118: 102-108.

1. Clausen JD, Goel VK, Traynelis VC, et al. Uncinate processes and Luschka joints influence the biomechanics of the cervical spine: quantification using a finite element model of the C₅-C₆ segment. J Orthop Res, 1997, 15(3): 342-347.
2. Choi KY, Eun SS, Lee SH, et al. Percutaneous endoscopic thoracic discectomy; transforaminal approach. Minim Invasive Neurosurg, 2010, 53(1): 25-28.
3. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11(6): 605-616.
4. Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143: 90-94.
5. Liao C, Ren Q, Chu L, et al. Modified posterior percutaneous endoscopic cervical discectomy for lateral cervical disc herniation: the vertical anchoring technique. Eur Spine J, 2018, 27(6): 1460-1468.
6. Liu C, Liu K, Chu L, et al. Posterior percutaneous endoscopic cervical discectomy through lamina-hole approach for cervical intervertebral disc herniation. Int J Neurosci, 2019, 129(7): 627-634.
7. Yu KX, Chu L, Yang JS, et al. Anterior transcorporeal approach to percutaneous endoscopic cervical diskectomy for single-level cervical intervertebral disk herniation: case series with 2-year follow-up. World Neurosurg, 2019, 122: e1345-e1353.
8. 杨俊松, 楚磊, 邓忠良, 等. 前路经椎体内入路全内镜下减压治疗单节段颈椎间盘突出症临床研究. 中国修复重建外科杂志, 2020, 34(5): 543-549.
9. 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.
10. 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.
11. 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.
12. Ren Y, Yang J, Chen CM, et al. Outcomes of discectomy by using full-endoscopic visualization technique via the transcorporeal and transdiscal approaches in the treatment of cervical intervertebral disc herniation: a comparative study. Biomed Res Int, 2020, 2020: 5613459. doi: 10.1097/MD.0000000000013456.
13. Kim CH, Shin KH, Chung CK, et al. Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical diskectomy. Global Spine J, 2015, 5(1): 31-38.
14. 邓忠良. 从机体内环境稳态理解微创脊柱外科手术的内涵与原则. 中华创伤杂志, 2015, 31(10): 865-867.
15. 邓忠良. 经皮脊柱内镜手术的相关问题. 中国骨伤, 2020, 33(5): 393-396.
16. Wu W, Yan Z. Intraoperative total spinal anesthesia as a complication of posterior percutaneous endoscopic cervical discectomy. Eur Spine J, 2018, 27(Suppl 3): 431-435.
17. 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.
18. Ahn Y. Percutaneous endoscopic decompression for lumbar spinal stenosis. Expert Rev Med Devices, 2014, 11: 605-616.
19. Li ZZ, Hou SX, Shang WL, et al. Percutaneous lumbar foraminoplasty and percutaneous endoscopic lumbar decompression for lateral recess stenosis through transforaminal approach: Technique notes and 2 years follow-up. Clin Neurol Neurosurg, 2016, 143: 90-94.
20. Ruetten S, Komp M, Merk H, et al. Recurrent lumbar disc herniation after conventional discectomy: a prospective, randomized study comparing full-endoscopic interlaminar and transforaminal versus microsurgical revision. J Spinal Disord Tech, 2009, 22(2): 122-129.
21. Chu L, Yang JS, Yu KX, et al. Usage of bone wax to facilitate percutaneous endoscopic cervical discectomy via anterior transcorporeal approach for cervical intervertebral disc herniation. World Neurosurg, 2018, 118: 102-108.

Chinese Journal of Reparative and Reconstructive Surgery

Posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation

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