A Novel Posterior Trench Approach Involving Percutaneous Endoscopic Cervical Discectomy for Central Cervical Intervertebral Disc Herniation

Abstract

As a supplement to the described surgical techniques of PECD, this trench approach provides novel access for the treatment of CIVDH, especially for the central type. The advantages of this technique include the provision of access to decompress the ventral region of the thecal sac and the ability to avoid damage to the facet joint. The steep learning curve might be a major disadvantage, and the sample volume is a limitation of the study; the effectiveness and reliability of the trench approach should be further verified in a comparative cohort study with a large volume of patients.

Clinical effectiveness of percutaneous endoscopic spinal surgery via transforaminal approach for single-level thoracic ossification of the posterior longitudinal ligament

“…Several studies [5,22,24] indicated that the risk of surgically induced instability was minimized via resecting a portion of the facet joint and medial part of the pedicle during the treatment of PESS for lumbar recess stenosis. Moreover, in our previous study [7,8] on PESS for cervical disc herniation, postoperative bone healing was found in both the medial part of pedicle and the trench of the posterior margin of the vertebral wall with CT examinations at the 6-month follow-up.…”

“…2A-B). And then the medial part of the pedicle and a minor portion of the posterior vertebral wall were drilled via the "trench approach" as we previously described [7], to create a groove for endoscopic manipulation and to fully expose the dural sac and base part of ossi ed posterior longitudinal ligament ( Fig. 2C-E, Fig.…”

Morphology of Herniated Disc as a Predictor for Outcomes of Posterior Percutaneous Full‐endoscopic Cervical Discectomy in Treating Cervical Spondylotic Radiculopathy

“…To a certain extent, these theories can be used to explain the clinical significance and predictive potential of CDHCA cut‐off we introduced for post‐PPECD outcomes. Recently, a novel trenching technique shows a promising prospect in treating median CDH 27 , which extends the indications of PCED for CS. The morphological parameters we introduced may serve as an effective indicator for better selection between conventional or trenching PPECD procedures.…”

Posterior Endoscopic Cervical Decompression: Review and Technical Note

“…17 Through a more lateral and caudal posterior access which oriented from lateral mass of lower vertebra, with drilling of part bony portions of the pedicle and vertebral body, the endoscope can access the spinal canal and remove the ventral nucleus pulposus without stimulation of spinal cord. 18,19 Although a few new techniques have been reported, it is currently limited outcomes still regarding long-term follow-up and complication profiles. In particular, it is important that the continuous intraoperative electromyogram, somatosensory-evoked potentials, and intermittent transcranial motor-evoked potentials should be monitored for spinal cord safety.…”

“…Endoscopic laminoplasty has been reported with favorable outcomes with less perioperative complications for cervical myelopathy [ 17 ]. Through a more lateral and caudal posterior access which oriented from lateral mass of lower vertebra, with drilling of part bony portions of the pedicle and vertebral body, the endoscope can access the spinal canal and remove the ventral nucleus pulposus without stimulation of spinal cord [ 18 , 19 ]. Although a few new techniques have been reported, it is currently limited outcomes still regarding long-term follow-up and complication profiles.…”