Endoscopic Anterior Cervical Discectomy and Fusion (ACDF)In this study, surgeons from the People's Republic of China report on the use of a microscope to perform an anterior cervical discectomy and fusion (ACDF). This technique is called an endoscopic approach.
The authors provide intraoperative photos showing the insertion of a working channel. The channel allows the surgeon to use surgical tools without cutting a large opening. A tiny TV camera on the end of the microscope (endoscope) showed the removal of the damaged disc. Taking the disc out removes pressure from the nerve tissue. This operation is called a decompression.
A fusion cage was inserted in the open space left by the disc that was removed. Another photo showed the fusion cage in place. X-rays and CT scans taken before and after the ACDF helped show the results. Pain levels, motion, and function were also used to measure the outcomes.
The endoscopic method of decompression and fusion has been used for a long time in the lumbar spine. The small area and closeness to the vocal cords has kept this from being used routinely in the cervical spine (neck).
Surgeons must have special training to do microendoscopic discectomy. The procedure is best done at C45 and C56 levels. The jaw gets in the way of inserting the working channel any higher. Blood vessels to the thyroid are at risk of injury if working any lower.
Some patients are not good candidates for anterior cervical endoscopic surgery. For example, narrowing of the spinal canal (called stenosis) makes it difficult to get full decompression. Likewise, hardening and thickening of the posterior longitudinal ligament (OPLL) requires an open incision.
The good-to-excellent results in this study suggest this procedure works well in carefully chosen patients. The fusion rate was 100 per cent. The rate of complication was very low. Anyone with a blood clotting disorder or cervical dislocation is not a good candidate for anterior endoscopic microsurgery.
The authors hope that future improvements in surgical tools and techniques will expand the use of this procedure for more patients. A device is needed that can apply traction to pull the vertebral bones apart. Special tools to help get around anatomical barriers are also needed.
Jiangwei Tan, MD, et al. Anterior Cervical Discectomy and Interbody Fusion By Endoscopic Approach: A Preliminary Report. In Journal of Neurosurgery. January 2008. Vol. 8. No. 1. Pp. 17-21.
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