Abstract
Background
Given that highly migrated cervical disk herniation (CDH) is a rare condition, its treatment remains controversial as reported by Srinivasan (2011). When the primary pathology is located posterior or lateral to the lateral edge of the spinal cord that causes a foraminal or far lateral disk herniation, a posterior full-endoscopic cervical discectomy (pFECD) may be appropriate as reported by Ahn (2020).
Methods
We introduced the pFECD with retrocorporeal technique and hemilaminectomy performed on a case of C4/C5 highly downward migrated CDH with left C5/C6 cervical neural foraminal stenosis (Fig. 1).
Conclusions
pFECD with retrocorporeal technique and hemilaminectomy could be an effective and minimally invasive option for highly migrated CDH.
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References
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Acknowledgements
The authors thank Enago (www.enago.tw) for providing professional English editing services.
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Contributions
Conceptualization: Chien-Min Chen; writing—original draft preparation: Su-wei Ou; writing—review and editing: Jae-Hwan Lee; resources: Chien-Min Chen and Yu-Hsiang Lin; and supervision: Chien-Min Chen and Yu-Hsiang Lin.
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Key points
I. Highly migrated CDH is rare. In most cases, the disk fragments were located anterior or lateral to the dura.
II. This technique is indicated for highly migrated CDH that the main prolapsed disk is located lateral to the lateral margin of the spinal cord.
III. The “V” point is defined as the junction of the confluence of the cephalad and the caudal lamina-facet junction with a V-shaped configuration and is the first landmark we should identify.
IV. Hemilaminectomy creates a larger working space that improves visualization and accessibility.
V. Disturbance to the pedicle or facet joint should be reduced to prevent cervical spine instability.
VI. The retrocorporeal technique additionally creates ventral epidural space for extraction and can get further into the middle portion of the migrated CDH.
VII. Retraction of the spinal cord or nerve root will not be necessary, decreasing the possibility of injury to the neural elements.
VIII. The end point of the operation was to see freely pulsating neural elements under irrigation and use hooks or forceps to check that there is no residual element beneath the dura sac.
IX. The patient can ambulate immediately after awakening from anesthesia, but a neck collar should be used.
X. Long-term follow-up is necessary to assess cervical spine stability and recurrence.
This article is part of the Topical Collection on Spine – Other.
Chien-Min Chen and Yu-Hsiang Lin have contributed equally to this article.
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Ou, Sw., Lee, J.H., Chen, CM. et al. How I do it? Posterior full-endoscopic cervical discectomy with retrocorporeal technique and hemilaminectomy for highly migrated cervical disk herniation. Acta Neurochir 165, 159–163 (2023). https://doi.org/10.1007/s00701-022-05425-1
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DOI: https://doi.org/10.1007/s00701-022-05425-1