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Anterior Cervical Endoscopic Microdiscectomy

What does “Anterior Cervical Endoscopic Microdiscectomy” mean?

Here is the meaning of each word:

  1. Anterior: from the front of the spine
  2. Cervical: the part of the spine located in the neck
  3. Endoscopic: using a small fiberoptic tube to see the inside of the spine
  4. Microdiscectomy: removing parts of a disc with minimal invasiveness

Altogether, “Anterior Cervical Endoscopic Microdiscectomy” mean to remove small portions of a disc in the neck minimally invasively, using an endoscope.

What is an Anterior Cervical Endoscopic Microdiscectomy?

This procedure is a minimally invasive spine surgery which removes disc material from a protruding or herniated disc in the neck. It uses a small endoscope to see inside the disc and small graspers (forceps) placed through the endoscope to remove the disc material.

Why is an Anterior Cervical Endoscopic Microdiscectomy done?

This surgery is done to remove disc material which is pushing on a spinal nerve causing pain.

What is the difference between an Anterior Cervical Endoscopic Microdiscectomy and other Cervical Discectomies?

Percutaneous and Endoscopic Cervical Discectomies typically require that the disc itself is salvageable. This means, that even though the disc is diseased by a disc herniation, the disc as a whole can still function as a shock absorber once the herniation is removed. An Anterior Cervical Discectomy and Fusion (ACDF) removes the entire disc since the disc is deemed non-salvageable.

1. An Anterior Cervical Endoscopic Discectomy is done from the front of the spine. It is a minimally invasive spine surgery which removes disc material from a protruding or herniated disc in the neck. It uses a small endoscope to see inside the disc and small graspers (forceps) placed through the endoscope to remove the disc material.

2. A Cervical Percutaneous Discectomy is done through a needle placed into the disc from the front of the spine. This procedure uses a small needle like device (e.g. nucleoplasty wand) to remove disc material with the help of an X-Ray machine. It does not remove much disc material and does not put anything into the disc.

3. A Cervical Endoscopic Discectomy is done from the back of the spine. Tubes are placed into the spine to gain access to the disc and requires removing a small portion of bone (laminotomy) in the process. It is a minimally invasive procedure which uses small instruments to remove a piece of disc. This procedure can remove more disc material than a Cervical Percutaneous Discectomy. The disc can also be seen with the endoscope.

4. An Anterior Cervical Discectomy and Fusion (ACDF) is an open surgery, not minimally invasive. It is done from the front of the spine. An incision and dissection is required (dividing tissue to see the next structure below). An ACDF surgery removes most of the disc and then places bone or bone-like material into the space to allow it to fuse together (become one piece of bone).

How is an Anterior Cervical Endoscopic Microdiscectomy done?

Here are some of the steps of how this surgery is done:

  1. An intravenous catheter (IV) is placed and an antibiotic given.
  2. The patient is given a General Anesthetic (put to sleep for the procedure).
  3. The patient is placed on their back (supine), often with the head straight and secured.
  4. The neck is cleaned with a surgical antiseptic and sterile plastic sheets (drapes) are placed around the site of the surgery to keep the area clean.
  5. An X-Ray machine is used to find the correct disc level in the spine.
  6. A small amount of local anesthetic may be injected under the skin.
  7. After locating the correct disc with an X-Ray machine, a needle is placed through the skin and advanced onto the disc.
  8. A wire is placed through the needle and left in place after the needle is removed.
  9. A small dilator tube is placed over the wire to widen the area slightly.
  10. A working channel (larger tube) is placed over the dilator, which is then removed.
  11. An endoscope is placed through the working channel.
  12. The inside of the disc is seen. A small grasper and other instruments are placed through the endoscope. Disc material can be removed with these instruments while looking at the inside of the disc with the endoscope.
  13. Once an adequate amount of disc material has been removed, all the instruments are taken out.
  14. A sterile bandage (dressing) is placed.
  15. The patient is awoken from Anesthesia and taken to the Recovery Area for observation.

How long does an Anterior Cervical Endoscopic Microdiscectomy take?

This surgery can take about 1-1.5 hours to complete for each disc treated.

What is the recovery like from an Anterior Cervical Endoscopic Microdiscectomy?

    1. This procedure is done on an outpatient basis. After a period of observation and recovery from the anesthetic, the patient is sent home.
    2. The wound area is kept clean and dry for at least 24 hours.
    3. The patient’s activity level is often restricted for a short period of time.
    4. The patient is usually seen by the doctor within a few weeks to reassess the symptoms

What kind of benefits can patients gain from an Anterior Cervical Endoscopic Microdiscectomy?

Results from disc procedures can vary. There is much debate among spine specialists as to how much disc material can be removed with these procedures. Patients can potentially benefit from this procedure for the long term. However, long-term studies have not been completed.