Transpedicular percutaneous endoscopic cervical discectomy for a highly Down-migrated C7-T1 disc: a case report

Disc herniations at the cervicothoracic junction (C7-T1) are uncommon, accounting for only 3.5% to 8% of all cervical disc herniations (CDH), with severely displaced herniations being even rarer. Although standard anterior approaches can be used to treat most cases of C7-T1 disc herniation, it is still a challenge to use this approach when the herniated lesion has migrated downward behind the T1 vertebral body.

A 50-year-old male patient presented with right neck and upper limb pain and right upper limb weakness for more than 10 days. Neurologic examination revealed mild weakness of the right hand intrinsic muscles (Grade IV/V) and a positive Spurling's sign. Magnetic resonance imaging (MRI) showed a C7-T1 disc extrusion that migrated caudally to the right posterior edge of the T1 vertebral body. A novel transpedicular approach of percutaneous endoscopic cervical discectomy (PECD) was performed under local anesthesia to address a migrated disc herniation at the C7-T1 levels. The patient experienced immediate pain relief, mobilized 2 h postoperatively, and was discharged 7 days after surgery.

Accessing the upper thoracic vertebral bodies via standard anterior approaches presents considerable challenges. It may require manubriotomy or sternotomy, which carry a significant risk of morbidity. As a supplementary approach to the minimally invasive technique of PECD, the transpedicular approach offers a novel access route for the treatment of CDH, especially at C7-T1 levels. This specific technique eliminates the need for sternotomy, provides a clear view, and preserves the motion segment at the cervicothoracic junction.