Cervical Microendoscopic Decompression/Discectom
Minimally Invasive Surgery to Treat “Pinched Nerves”
by Dr. Paul J. Tsahakis, MD
The surgical options available to treat a symptomatic cervical radiculopathy—a.k.a. “a pinched nerve”—include both anterior and posterior approaches. While safe and effective, an anterior approach requires fusing together two vertebrae with a bone graft and plate. This generally requires a hospital stay of one to three days. Historically, fusion has also been associated with accelerated degeneration of adjacent discs, a consequence that frequently requires subsequent surgery.
Open posterior approaches are also safe and effective in decompressing the neural elements. Furthermore, they have the added benefit of not requiring a fusion. Appropriate candidates for this surgical approach have laterally herniated discs and/or bony foraminal stenosis. These two conditions account for the vast majority of patients who require surgical treatment.
A further refinement of the posterior approach is cervical microendoscopic decompression, a minimally invasive solution for this common clinical problem. Candidates for this procedure include any individual who is experiencing pain in an arm due laterally compressive lesions at one or two spinal levels, and who has not responded to conservative treatment. Performed through an 18-millimeter posterior cervical incision, the procedure uses a guide wire to pass dilators that gently spread the paraspinal musculature. The surgeon places a cannula through this incision in order to align an operating microscope in order to visualize and assist in removing any compressive lesions.
The paraspinal muscles are left attached to the spine in this procedure, resulting in less discomfort and a faster recovery than with open approaches. In fact, patients typically leave the hospital four or five hours after the procedure and are allowed to shower the next day. Postoperative neck braces are not necessary and most patients are able to resume normal activities within a matter of days.
In December 2003, I reported my results utilizing this minimally invasive outpatient technique at the prestigious Cervical Spine Research Society. Excellent or good clinical results were reported in 97% of the cases. Additionally, no neural complications or infections were noted.
The surgeons at Total Spine Specialists have been successfully utilizing cervical microendoscopic decompression since 1998, and our lengthy experience has demonstrated its safety and effectiveness. It remains our first choice for patients who require surgery to treat their cervical radiculopathy.
For more information regarding cervical microendoscopic procedures, or for a copy of Dr. Tsahakis’s paper, “Cervical Microendoscopic Decompression for Radiculopathy: Surgical Technique and Results,” please contact Total Spine Specialists at 704–446–7540.
Should You Consider Microendoscopic Surgery?
Cervical and lumbar disc herniations occur when part of the central portion of the disc sticks out and compresses a nerve root. The nerve roots leave the spinal cord and travel down the arms and legs. A compressed nerve root can be very painful and the symptoms can come on suddenly without any known triggering event.
Patients with a cervical disc herniation suffer from neck and arm/hand pain and numbness. This pain and numbness may involve some or all of the fingers or backside of the forearm. It does not usually involve both arms. Patients will often find that placing their hand on their head relieves the pain.
A herniated disc in your lower back will cause leg pain and numbness. Patients find it is very difficult to sit, and the pain gets worse when they raise a leg.
The majority of patients who are suffering from pain or numbness in their arms or legs due to compressed nerve roots in the cervical or lumbar spine are good candidates for microendoscopic discectomy surgery. If you think that you are suffering from a compressed nerve root, talk to your physician in order to determine the treatment options that work best for you.
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