Endoscopic Cervical Discectomy
Endoscopic cervical discectomy is a minimally invasive surgical technique in which a disc fragment compressing a nerve root in the neck is removed using an endoscope inserted through a small incision. In selected cases it aims to preserve motion without fusion and to reduce tissue damage.
Ostatnia aktualizacja: 2026-06-08
Definition
Endoscopic cervical discectomy is the removal of disc material compressing a nerve root in a cervical disc herniation through a thin endoscopic system. The procedure is performed under high magnification with an endoscope carrying a camera and light source through a millimetric corridor. The neck can be approached from the posterior route or, in selected cases, the anterior route; the posterior endoscopic approach usually does not require fusion. The method is a minimally invasive approach that has developed as an alternative to classic open or microsurgical techniques.
Indications
The technique is considered in selected patients with arm radicular pain (radiculopathy) from a cervical disc herniation demonstrated on imaging and concordant with clinical findings, who have not responded to adequate conservative treatment. It is most suitable for laterally located, foraminal soft disc herniations. In the presence of significant spinal cord compression (myelopathy), broad multilevel stenosis, instability, or advanced bony degeneration, this method alone may be insufficient and alternatives such as ACDF may be preferred. Suitability is assessed by the location and type of the herniation and the anatomy.
Procedure
The procedure is performed under general anesthesia or, in some centers, local/sedation anesthesia. In the posterior approach the patient is placed prone, the target level is confirmed with fluoroscopy, and a thin working cannula is placed at the foraminal region. The endoscope is advanced through this cannula; a limited foraminotomy exposes the nerve root, and the disc fragment compressing it is removed with specialized endoscopic instruments. In the anterior endoscopic technique the disc is reached through a thin corridor from the front. After confirming that the nerve root is decompressed, the cannula is withdrawn and the small incision is closed.
Advantages and Limitations
Reported potential advantages include a very small incision, little soft-tissue disruption, avoidance of fusion in the posterior approach, and early mobilization in many patients. However, the technique has a significant learning curve and a narrow indication window; not every type of herniation or level is suitable. In conditions such as myelopathy from spinal cord compression, a large central herniation, significant instability, or multilevel spondylosis, ACDF or microsurgical techniques may be more appropriate. Outcomes depend largely on patient selection.
Recovery and Risks
Recovery time varies by patient and procedure; because of the small incision, many patients can mobilize early. As with all spine surgery, possible risks include infection, bleeding, dural tear and cerebrospinal fluid leak, nerve root or spinal cord injury, and recurrence at the same level. Additional (open or fusion) surgery may be required for inadequate decompression. No outcome is guaranteed; the decision is individualized by considering the patient's clinical status and imaging findings together.
Źródła
- Ruetten S, et al. Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: prospective randomized controlled study. Spine. 2008.
- Greenberg MS. Greenberg's Handbook of Neurosurgery. 10th ed. Thieme; 2023:1280.
- Ahn Y. Endoscopic cervical discectomy for cervical disc herniation: techniques and outcomes. Neurospine / review literature.
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