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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
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
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:
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:
Severe neck and arm pain; with or without weakness,
numbness, or tingling.
Certain selected cases of neck pain only.
Pain that has not responded to
conservative treatments; i.e. cervical collar, cervical traction,
analgesics, chiropractic, physical therapy and/or muscle
Patients with multiple cervical disc protrusions
Herniated cervical discs (prolapsed, ruptured, protruded, extruded,
and free fragments) confirmed by radiologic studies that may
include one or more of the following:
Magnetic resonance imaging
Enhanced CAT scan
Patients who have small bone spurs associated with a disc protrusion
are also candidates.
Patients with disc protrusions and bone spurs at adjacent levels
benefit from the CED/ACD combination procedure.
Who Should Not Consider This Procedure?
Patients who have neck pain or arm/hand pain not caused by
a herniated disc
Patients who have severe spinal stenosis
(build-up of bone in the spinal canal)
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 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.
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
The structure of the disk still
maintained (Only 10-15% is removed)
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