Percutaneous endoscopic cervical discectomy (PECD) was designed to
bridge the gap between failed medical- and interventional care for cervical
radiculopathy due to small herniated discs and traditional open anterior cervical
discectomy surgery many of which employ fusion and far fewer motion preservation
strategies. PECD can be divided into the anterior transdiscal- and the posterior
interlaminar approach. Anterior PECD has been criticized for the potential propagation
of cervical disc collapse due to the more aggressive disruption of the anterior annulus.
Additional limitations of the anterior transdiscal PECD may become relevant when
upward or downward disc fragments are entrapped behind the vertebral body. Even
during ACDF, a corpectomy may be required to remove these far-migrated disc
fragments. Therefore, the authors advocated for the anterior transcorporeal approach
through a small bony channel through a cervical vertebral body. The surgical trajectory
can be freely aimed at the compressed pathology giving the surgeon more flexibility to
remove the herniated disc while preserving the motion of the surgical- and possibly
adjacent segments by limiting the bony resection required to gain access to the disc
herniation. The authors present case examples to illustrate the involved surgical steps,
required equipment, discuss pitfalls, and technical details to achieve reliable clinical
improvements without complications. This simplified anterior cervical decompression
procedure improved their patients without surgery-related complications, such as
dysphagia, Horner’s syndrome, recurrent laryngeal nerve palsy, vagal nerve injury,
tracheoesophageal injury, or anterior cervical hematoma. The authors concluded that
the transcorporeal PECD is suitable for the outpatient setting in an ambulatory surgery
center, provides excellent direct visualization of the herniated disc with little iatrogenic
injury to the cervical spine. Thus, it minimizes the risk of secondary decline of
intervertebral height due to access-induced advanced cervical disc degeneration
commonly seen with anterior transdiscal approaches.
Keywords: Cervical spine, Discectomy, Endoscopy, Herniated disc, Minimally
invasive surgery, Transcorporeal approach.
