Endoscopic disc surgery on the cervical spine
In the cervical spine are degenerative, radicular symptoms, ie arm pain, typically by mediolateral to lateral (side location) often caused disc herniations. Despite good results of the conservative treatment a surgical procedure may be required for persistent pain or neurological deficits. To date, the ventral approach (ie from the front) has developed a standard decompression and fusion procedures in the surgery of the cervical spine. It is a safe procedure with good fusion rates. Nevertheless, specific problems such as subsidence of the implants, nonunion or access complications are described (dysphagia, hoarseness). Particular disadvantages of fusion (stiffening) adjucent level degeneration are discussed. Here is trying to get the segment mobility by intervertebral disc prostheses. But this is disappointing in about 30% of cases.
The technique of full-endoscopic discectomy on the cervical spine
The most common alternative approach to the ventra discectomy is the dorsal foraminotomy. It is carried out without any additional stabilization and thus preserves the motion.
For herniated discs on the cervical spine, the volume of the heniated disc material is usually low. Thus, the ventral and also the open dorsal approach often requires a relatively extensive intervention in relation to the rather small herniated disc. Full-endoscopic surgery of the cervical spine are rarely carried out and need a lot of experience as a risk for a spinal cord injury is allways present.
By improving the ability of endoscopes and endoscopic tools it was possible to operate even herniated discs in the cervical spine without aditional risks. Benefits are minimal skin incision, no separation of muscles, thus no neck pain, no removal of the disc, only removal of the heniated material and relieve the nerve. The rest of the disc can recover.
[Translate to English:] Bei der endoskopischen Bandscheibenchirurgie an der Halswirbelsäule wird in Bauchlage unterm Röntgen die Höhe markiert und dann über eine Stichinzision der Trokar an die richtige Stelle platziert. Darüber wird eine Hülse geführt und dann mit einem speziellen Bohrer die so genannte Foraminotomie durchgeführt, d.h. Bildung eines kleinen Fensters von ca 5mm Durchmesser. Dann wird mit Mikroinstrumenten der Vorfall präpariert und entfernt.