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Decompression for cervical disc herniation using the full-endoscopic anterior technique

  • S. OezdemirEmail author
  • M. Komp
  • P. Hahn
  • S. Ruetten
Operative Techniken
  • 201 Downloads

Abstract

Objective

Resection of a cervical disc herniation using a full-endoscopic technique with an anterior approach.

Indication

Fresh disc herniation with monoradicular symptoms in the upper extremity.

Contraindications

Pure neck pain, cervical myelopathy, older and calcified disc herniations, higher grade of instability and deformity.

Surgical technique

Introduction of a guidewire and dilatator to a cervical disc using an anterior approach. Under full-endoscopic view, preparation of the posterior parts of the annulus, opening of the annulus and posterior longitudinal ligament and resection of the herniated fragment from the epidural space.

Postoperative management

Immediate mobilisation, isometric/coordinative exercises, functional exercises from week 3, building up strength from week 6.

Results

A total of 120 patients were operated using the full-endoscopic or microsurgically assisted technique and were followed up for 24 months. Significant improvement was achieved in both groups. The group of full-endoscopic operated patients returned to work significantly earlier and 89% of all patients would undergo the operation again.

Keywords

Disc prolapse Cervical disc herniation Endoscopic surgical procedures Surgical decompression Microsurgery 

Dekompression beim zervikalen Bandscheibenvorfall in vollendoskopischer, ventraler Technik

Zusammenfassung

Operationsziel

Entfernung eines frischen zervikalen Bandscheibenvorfalls in vollendoskopischer Technik mittels ventralem Zugang.

Indikation

Frischer Bandscheibenvorfall mit monoradikulärer Symptomatik der oberen Extremität.

Kontraindikationen

Reine Nackenschmerzen, zervikale Myelopathie, alte verkalkte Bandscheibenvorfälle, höhergradige Instabilität und Deformität.

Operationstechnik

Einführen eines Führungsdrahts in eine zervikale Bandscheibe von ventral, in Dilatatortechnik Einbringen der Operationshülse. Unter vollendoskopischer Sicht Präparation zum dorsalen Annulus, Eröffnung des Anulus und des posterioren longitudinalen Ligaments sowie Resektion des Sequesters aus dem Epiduralraum.

Weiterbehandlung

Sofortige Mobilisation, isometrische/koordinative Übungen, ab der 3. Woche funktionelle Übungen, ab der 6. Woche Muskelaufbau.

Ergebnisse

Insgesamt wurden 120 Patienten in vollendoskopischer oder mikrochirurgisch assistierter Technik operiert und über 2 Jahre nachuntersucht. Signifikante Verbesserungen wurden in beiden Gruppen erreicht. Die Gruppe der vollendoskopisch operierten Patienten kehrte signifikant früher in den Beruf zurück. Etwa 89 % aller Patienten würden den Eingriff erneut durchführen lassen.

Schlüsselwörter

Bandscheibenprolaps Zervikaler Bandscheibenvorfall Endoskopische Operationsmethoden Operative Dekompression Mikrochirurgie 

Notes

Compliance with ethical guidelines

Conflict of interest

S. Oezdemir, M. Komp, P. Hahn and S. Ruetten declare that they have no competing interests.

This article does not contain any studies with human participants or animals performed by any of the authors.

The supplement containing this article is not sponsored by the industry.

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Copyright information

© Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2018

Authors and Affiliations

  1. 1.Zentrum für Wirbelsäulenchirurgie und Schmerztherapie, Zentrum für Orthopädie und UnfallchirurgieSt. Elisabeth Gruppe—Katholische Kliniken Rhein-Ruhr, St. Anna Hospital HerneHerneGermany

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