PERCUTANEOUS SURGICAL CERVICAL DISCECTOMY: TECHNIQUE AND RESULTS

Abstract

Purpose: Since 1990, we have used specific material, presented to us by T. Tajima (Japan) during his visit in 1989 for percutaneous surgical cervical discectomy. French material was developed in 1992. The purpose of this work is to present our experience with this technique over the last ten years.

Material and methods: Indications were cervicobrachial neuralgia unresponsive to medical care and secondary to MRI or CT documented cervical disc herniation. We used the right anterolateral approach guided with the image amplifier for patients under local anaesthesia and neuroleptanalgesia ou general anaesthesia. A guide wire was positioned in the centre of the anterior aspect of the disc to insert a 2.5 mm working tube in the middle of the disc. A special trephin with an inverted inside thread induced an aspiration effect when turned into the disc, in line with the posterior wall of the vertebra. This enabled removal of several “carrots” measuring 1 to 2 cm long of discal or even disco-osteophytic material. The removal of the posterior third of the disc and the herniation was completed with a fine disc forceps.

Results: There were 85 procedures in 82 patients, mean age 42 years (35 women, 47 men): 57 at one level, mainly C5C6, 27 at two levels simultaneously, and one at three levels during the same operation. Mean follow-up for the 80 results known was 15 months (3–90 months). There were nine failures (two required conventional surgical fusion), 14 fair results, and 57 good results, giving a total of 88.75% good and fair results. Unlike percutaneous surgical lumbar discectomy, where good results at three months may deteriorate at two years, good results at three months after percutaneous cervical discectomy remained good at two years.

Discussion: This technique provides results as good as chemonucleolysis. An advantage of the technique that allergy or disco-osteophytic protrusions are not contraindications. We did not have any infection or injury to neighbouring tissue.

Conclusion: When rigorous operative procedures are used in this area with potential risk, percutaneous surgical cervical discectomy can be a useful routine therapeutic tool.