Cervical Endoscopic Discectomy

Cervical Endoscopic Discectomy (CED) for the relief of neck and arm pain

What are Cervical Discs?
Cervical discs are the structures which serve as shock absorbers between the vertebrae of the spinal column. The center of the disc, called the nucleus, is soft and springy and accepts the shock of standing, walking, running. etc. The outer ring of the disc, called the annulus, provides structure and strength to the disc. The annulus is comprised of a complex series of interwoven layers of fibrous tissues which hold the nucleus in place.

What is a Herniated Disc?
Herniated discs are often called a "slipped disk". This term was derived from the action of the nuclear tissue when it is forced from the center of the disc. The disc itself does not slip. However, the nuclear tissue located in the center of the disc can be placed under so much pressure that it can cause the annulus to herniate or rupture. When the disc has herniated or ruptured, it may create pressure against one or more of the spinal nerves which can cause pain, weakness or numbness in the neck and arm. Other vernacular terms for a herniated disc are a "protruded disk" or a " ruptured disk".

Treatments for Herniated Cervical Discs
Depending upon the results of the physical and radiologic examination and the severity of your condition, your doctor may offer you two forms of treatment. The first common treatment prescribed for neck pain caused by the herniated cervical disc is conservative therapy. Conservative therapy may consist of a period of a cervical collar, cervical traction, analgesics, chiropractic and/or physical therapy.

However, if after therapy the pain has not been relieved, an outpatient surgical procedure may be considered. My philosophy, as a herniated disc surgeon, is to do the least invasive surgical procedure which combines the least surgical risk with the greatest opportunity for success. Outpatient procedures are also less costly. Surgical treatments for herniated cervical discs include:

1. Cervical endoscopic discectomy (CED)
2. Anterior cervical discectomy (microscopic)
3. Anterior cervical discectomy and fusion (ACF)
4. Cervical laminectomy

History of Cervical Endoscopic Discectomy:
CED is an outpatient surgical procedure to remove herniated disc material. It has been performed in Europe successfully since 1991. I studied with Dr. Jacque Theron, who pioneered the procedure in Europe, and I began performing the procedure in 1994.

CED is different from open cervical disc surgery because there is no damage to the neck muscles, no bone removal or large skin incision. The risks of a fusion and its long term side effects (herniation of adjacent discs etc.) are avoided.

Who Should Consider This Procedure?
This procedure is specifically designed for patients with disc problems accompanied by the following:

1. Severe neck and arm pain; with or without weakness, numbness, or tingling.
2. Certain selected cases of neck pain only.
3. Pain that has not responded to conservative treatments; i.e. cervical collar, cervical traction, analgesics, chiropractic, physical therapy and/or muscle relaxants.
4. Patients with multiple cervical disc protrusions
5. Herniated cervical discs (prolapsed, ruptured, protruded, extruded, and free fragments) confirmed by radiologic studies that may include one or more of the following:
   • Cat scanning
   • Magnetic resonance imaging
   • Enhanced CAT scan
   • Myelography
   • Discography
6. Patients who have small bone spurs associated with a disc protrusion are also candidates.
7. Patients with disc protrusions and bone spurs at adjacent levels benefit from the CED/ACD combination procedure.

Who Should Not Consider This Procedure?

1. Patients who have neck pain or arm/hand pain not caused by a herniated disc
2. Patients who have severe spinal stenosis (build-up of bone in the spinal canal)
3. Patients with herniated disc and mild stenosis are still appropriate candidates for the procedure.

Only patients with clinical symptoms confirmed by physical examination and radiologic studies are considered for the CED procedure.

The Surgery
The procedure is performed in the operating room at an outpatient surgery center for those patients with small bone spurs associated with their disc protrusions, we have special instruments that enable us to also remove the bone spurs. The CED procedure usually is performed on an outpatient basis under intravenous sedation given by an anesthesiologist and also local anesthesia by Dr. Schiffer. In some cases Dr. Schiffer performs the CED under general anesthesia with evoked potential neurophysiologic monitoring. This type of monitoring adds significantly to the safety of the procedure.

After sedation and local anesthesia is provided, a 2mm skin opening is made. Then using x-ray guidance, a small guide is inserted into the disc. Over the guide, a 2mm tube is inserted in to the disk followed by the specially designed suction probe. The disc is visualized with an endoscope and is suctioned for approximately 10 minutes. Larger disc fragments are removed with specially designed forceps. Only the herniated portion (approximately 10% of the disc) is removed. The rest of the disc is left intact. The entire procedure usually takes 20 to 30 minutes. You will normally feel little, if any, pain or discomfort. Upon completion of the procedure, a band-aid is applied over the probe site.

After the surgery, you will still retain approximately 90% of your disk and it will not diminish significantly in height.

Note: For those patients with small bone spurs associated with their disc protrusions, we have special instruments that enable us to also remove the bone spurs.

Postoperative Course
Most patients feel immediate relief from pain following the procedure. Walking is permitted the same day and the patients are discharged from the surgery center that afternoon.

Following your discharge, a physical therapy program near your home is recommended. Little, if any, postoperative medication is required for most patients. Normal activity can usually be resumed within one to six weeks after the surgery.

Advantages
The primary advantage of this procedure is that there is no interference with the muscles, bones, joints or manipulation of the nerves in your neck. The risks of a fusion and its long term side effects (herniation of adjacent discs. etc.) are avoided. Since the probe placement is directly into the disc and avoids the spinal canal, there is no risk of post-operative scarring of the nerves. Additionally, because the procedure is performed under intravenous sedation and local anesthesia, it is much safer for the patient than that performed under a general anesthetic. Finally, because the procedure is performed on an outpatient basis, you will be allowed to return home the day of the surgery.

Typical Stay
Patients are normally seen in our clinic/office Day One, surgery is performed Day Two and on Day Three patients are once again evaluated after which they can return home.

Summary
Clinical results with Cervical Endoscopic Discectomy, as compared to alternative surgical procedures, have proven:

• Minimal discomfort (small puncture wound in the skin)
• No permanent paralysis or other neurological complications
• The structure of the disk still maintained (Only 10-15% is removed)
• No hospitalization
• Faster return to work and normal activity
• Because there is no hospitalization for this surgery, there is significant cost savings.

For more information about CED, please contact Dr. Schiffer.