Elsevier

World Neurosurgery

Volume 132, December 2019, Pages 47-52
World Neurosurgery

Case Report
Percutaneous Full-Endoscopic Anterior Transcorporeal Diskectomy for Massive Migrated Cervical Disk Herniation Treatment: Case Report and Review of the Literature

https://doi.org/10.1016/j.wneu.2019.08.054Get rights and content

Background

With the continuous advancement of the spinal endoscopic technique in recent years, full-endoscopic operations provide a new approach for the treatment of migrated cervical disk herniation.

Case Description

A 42-year-old man presented with nuchal pain and limb numbness for 2 months, with recently developed symptoms of unstable walking. Physical examination revealed a diminished skin sensitivity to pain and temperature, beginning at the C4 dermatome. The muscle strength of both upper limbs decreased to grade 4, and the muscle strength was grade 4 on both sides of the lower limbs. Hoffmann sign and ankle clonus were positive. Magnetic resonance imaging (MRI) and computed tomography (CT) scan demonstrated that a large piece of a segmental disk had migrated to the rear area of the C4 vertebral body and seriously compressed the spinal cord. A percutaneous full-endoscopic anterior transcorporeal cervical diskectomy was performed on the patient.

Conclusions

The postoperative Japanese Orthopaedic Association (JOA) score increased from 8 to 11 points. At 2-year follow-up, the JOA score was 16 points, the improvement rate was 88.9%, and cervical vertebrae MRI, cervical CT scan, and 3-dimensional reconstruction showed that the cervical vertebrae channel healed without vertebral fractures, bony channel collapse, adjacent segment degeneration, or intervertebral space height.

Introduction

According to Srinivasan et al.,1 a migrated cervical disk herniation refers to a detached disk fragment that has migrated behind the middle of the vertebral body and is compressing the anterior surface of the dural tube. Because the migrated cervical disk tissue is obstructed by the cervical vertebral body, it is difficult to fully expose and remove sequestrated herniated disk fragments during surgery. Some surgeons have reported that cervical corpectomy is sometimes required to remove a sequestrated disk at the posterior region of the vertebral body.1, 2 However, vertebral resection increases the mechanical stress on the adjacent segment and bears the risk of complications such as pseudarthrosis formation and internal implant collapse.3, 4, 5 In 2011, Choi et al.6 reported a successful case of a combined anterior approach with transcorporeal herniotomy for a massive migrated cervical disk herniation. This procedure avoids corpectomy when exposing the displaced cervical disk tissue. However, this surgical method still requires the separation of soft tissue, and the procedure requires the complete removal of the affected segmental disk. The surgical trauma is extensive and the risk of postoperative complications such as intervertebral height reduction, fusion failure, and accelerated degeneration of adjacent segments is great. With the continuous advancement of the spinal endoscopic technique in recent years, full-endoscopic operations provide a new approach for the treatment of migrated cervical disk herniation. However, according to a recent review, cervical endoscopic spinal surgery is mainly restricted to a few centers in the Far East, and to date is rarely used in Europe and the United States.7 In this study, we report a case in which percutaneous full-endoscopic anterior transcorporeal cervical diskectomy (PEATCD) was performed to treat a massive migrated cervical disk herniation without corpectomy.

Section snippets

Case Presentation

A 42-year-old man presented after experiencing neck and shoulder pain for 2 months. Physical therapy, acupuncture, and oral administration of nonsteroidal analgesics did not significantly relieve the pain. Neurologic examination revealed a decrease in skin sensation in the area innervated by the C4 segment, a decrease in muscle strength in both upper limbs to grade 4, and decreased (grade 4) muscle strength in both lower limbs. Hoffmann sign and ankle clonus were positive. The Japanese

Discussion

Cervical disk tissue can migrate to the anterior, posterior, or lateral aspects of the spinal canal, and the sequestrated cervical disk fragment is frequently found to consist of 2 or 3 pieces.2 Once the diagnosis is clear, surgery should be performed as soon as possible to completely relieve the pressure and to prevent irreversible damage to the nerve roots or spinal cord. However, the current surgical treatment for migrated cervical disk herniation is still inconclusive. According to previous

Conclusions

With the help of spinal endoscopy technology, the position of a bony channel can be flexibly designed according to the position of the sequestrated cervical disk fragment(s), with this method having the advantages of being minimally invasive and fast. The efficacy in our patient was more than satisfactory, indicating that PEATCD in the treatment of migrated cervical disk herniation has broad prospects. We expect that the efficacy and reliability of this technique will be further verified by

References (22)

  • K.-C. Choi et al.

    Combined anterior approach with transcorporeal herniotomy for a huge migrated cervical disc herniation

    Korean J Spine

    (2011)
  • Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

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