Percutaneous endoscopic cervical discectomy: Clinical outcome and radiographic changes

Objective: The purpose of this study was to evaluate the clinical outcome and radiographic changes of percutaneous endoscopic cervical discectomy (PECD) with the high-resolution working channel endoscope. Background data: Percutaneous disc decompression using a laser and/or microforceps for cervical disc herniation has been regarded as an effective treatment modality in selected cases. However, the postoperative radiographic changes have not yet been evaluated. Methods: We reviewed the clinical and radiographic records of 36 consecutive patients who underwent PECD with the working channel endoscope. The herniated discs were selectively removed by Ho:YAG laser and microforceps under high-resolution endoscopic visualization. The postoperative radiographic changes, including the disc height, the sagittal cervical alignment, and the segmental range of motion were measured. Results: The mean follow-up period was 28.6 months (range, 23-34 months). Based on the Prolo Scale, excellent outcomes were achieved in 19 of 36 patients (52.8%), good outcomes in 12 (33.3%), fair outcomes in three (8.3%), and poor outcomes in two (5.6%). The disc height significantly decreased by 11.2% of the original height (p < 0.001). However, the overall and focal sagittal alignments were well maintained. There was no segmental instability or spontaneous fusion. One patient required subsequent open surgery due to incomplete decompression. Conclusions: The high-resolution working channel endoscope allowed us to selectively remove the cervical herniated disc. The postoperative disc height reduction was observed, with no significant effect on therapeutic success. The sagittal alignment and segmental motion were well preserved.