Surgical Techniques Ensuring Success in Posterior Endoscopic Cervical Foraminotomy and Discectomy at C6-7 in Patients...

There is a steep learning curve for a successful posterior endoscopic cervical foraminotomy and discectomy (PECFD), an important surgery for cervical foraminal or lateral disc herniation, and cervical radiculopathy due to a small operation field. PECFD becomes even more challenging in patients who have prominent shoulders and/or short necks with C6-7-disc herniation, because of the difficulty to localize C6-7 vertebral structure under fluoroscopy. The study objective is to prove that the PECFD can be performed safely and successfully to C6-7-disc herniation on patients with prominent shoulders and/or short necks following our novel surgical techniques under fluoroscopic guidance.

PECFD was performed on a patient who had an extruded foraminal disc herniation at C6-7 on the left with left arm pain and weakness. Due to his prominent shoulders and a short neck, the C6-7 anatomic site was not visible under traditional anterior-posterior (AP) and lateral fluoroscopic views. The authors inserted a reference needle to C4-5 facets between C4 and C5 pedicles under AP and lateral fluoroscopic views. Following the reference needle, the C6-7 facets were easily located with an oblique fluoroscopic view. A large endoscopic cannula was used initially for adequate resection of C6-7 facets, followed by a small cannula for nerve root handling with minimal pressure and discectomy.

The novel surgical techniques resulted in a complete resection of the C6-7-disc herniation and resolution of the patient's radiculopathy with no postoperative complications.

PECFD can be safely and successfully applied for C6-7-disc herniation in patients with prominent shoulders and/or short necks using our novel surgical techniques.