Introduction
To demonstrate evolving out-patient anterior endoscopic microdecompressive cervical
discectomy, with low energy non-ablative Holmium laser for disc shrinking and tightening effect (laser
thermodiskoplasty), performed for treatment of symptomatic herniated cervical disc to be efficacious
and safe, and preserves spinal motion.
Indications
- Neck with arm pain (radicular pain) associated with paresthesia, sensory loss, muscle weakness and/or decreased reflexes
- Intractable cervicogenic headache
- No improvement after 12 weeks of conservative therapy
- MRI or CT scan positive for disc herniation
- Positive provocative discogram
- Positive EMG considered helpful
- Multiple discs can be treated at one sitting
- Post fusion junctional disc herniation syndrome
Material and Methods
Since 1994, 1260 patients (2097 Discs), males: 643 - females: 617, who failed at
least 12 weeks of conservative care were treated. Levels were C2 to C7, inclusive. All patients
demonstrated unilateral radicular pain of a specific dermatome, single level or multiple levels,
confirmed with EMG/NCV, MRI or CT scans demonstrated the herniated cervical disc. Anterior endoscopic
microdecompressive cervical discectomy technique is described. Non-ablative lower Holmium laser energy
was added for disc shrinkage.
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Results
Average time to return to work was ten days. At an average follow-up of 3 years. For
single level, 94% had good to excellent symptomatic relief and spinal motion preservation. There were
no intraoperative complications. Postoperatively, one patient with transient Horner's syndrome and one
transient hoarseness voice were noted. Seventy five patients had persistent neck and upper extremity
pain associated with paresthesia, after surgery.
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Conclusion
This evolving anterior endoscopic microdecompressive cervical discectomy with added
application of non-ablative lower Holmium laser energy for disc shrinkage (laser thermodiskoplasty),
has proven to be safe, less traumatic, easier, and efficacious with significant economic savings. It
preserves spinal motion and provides a channel for spinal arthroplasty. It is an effective alternative
or replacement for conventional open spinal surgery for discectomy, and can decompress stenosis, in
degenerative spine disease.
Learning Objective
The presentation provides the information for participants familiar with Anterior
Endoscopic Cervical Discectomy: 1. Recognize the surgical indication. 2. The surgical technique. 3.
Potential complications and avoidance.
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