Endoscope-assisted Anterior Cervical Discectomy and Fusion for the Treatment of Cervical Spondylotic Myelopathy

Summary

We describe a minimally invasive surgery using Endoscope-assisted Anterior Cervical Discectomy and Fusion for the Cervical Spondylotic Myelopathy.

Abstract

Cervical spondylotic myelopathy (CSM) is a common cause of cervical spinal cord disease. Spinal endoscopy offers surgical advantages such as a magnified view and a water-mediated clear surgical field. This study describes an endoscope-assisted anterior cervical discectomy and fusion (ACDF) procedure. The addition of spinal endoscopy to traditional ACDF surgery magnifies the surgical field and allows for more precise operations, thereby improving surgical safety. Postoperatively, patients experienced significant improvements in neurological function, with no complications such as dysphagia, hematoma, or spinal cord injury. Postoperative imaging revealed that spinal cord compression was completely relieved, with sufficient decompression of the spinal cord and optimal placement of the fusion cage. The clear visual field provided by spinal endoscopy improves the identification of cervical anatomical structures during surgery, effectively reducing the risk of injury to the spinal cord and nerves. Endoscope-assisted ACDF has demonstrated excellent clinical and radiological outcomes in the treatment of CSM.

Introduction

Cervical spondylotic myelopathy (CSM) is one of the more severe forms of cervical spondylosis. CSM is a group of syndromes caused by degenerative changes in the cervical spine, leading to degeneration of the surrounding structures such as intervertebral discs and ligaments. These structures subsequently compress the spinal cord, resulting in limb dysfunction or even paralysis. Early diagnosis and timely intervention are critical for improving patient prognosis. Surgical intervention is often required when conservative treatments fail or spinal cord dysfunction worsens^1,2.

Several su....

Protocol

This study was approved by the Ethics Committee of Hebei General Hospital. Informed consent was obtained from all individual participants.

1. Preoperative preparation

1. Before surgery, place the patient in a supine position on the hospital bed, with soft pillows under both shoulders and a cylindrical pillow under the occiput to maintain the cervical spine in a hyperextended position.
   NOTE: This step serves two purposes: (1) to allow the patient to adapt to the surgical position and (2) to assess, while the patient was awake, whether hyperextension aggravates any neurological symptoms.
2. Operation pl....

Results

This study included 20 patients who underwent endoscope-assisted ACDF surgery from January 2024 to November 2024. The average age was 62.2 years, and the study sample included 9 females and 11 males. The average operative time was 125.5 min, and the mean volume of blood loss was 59.0 mL (Table 1 and Table 2). All patients achieved successful relief of spinal cord symptoms, with lower postoperative visual analog scale (VAS) scores compared with the preoperative scores and significantly im.......

Discussion

Anterior cervical discectomy and fusion (ACDF) is a common surgical method for treating cervical spondylotic myelopathy (CSM) and has satisfactory clinical outcomes^13,14. However, traditional surgery faces challenges such as a limited surgical field and difficulties with hemostasis. These problems are particularly pronounced in cases of ossification of the posterior longitudinal ligament (OPLL) or distant disc herniation; in these cases, the compressive material .......

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
75% alcohol	Hebei Ruihe Medical Equipment Co., Ltd	CC-01A	PEEK
Anterior Cervical Nail Plate Fixation System	Hebei Ruihe Medical Equipment Co., Ltd	PN-03	Plate:TA3G, Nail:TC4
Cervical Fusion Cage
cisatracurium besylate	SPINENDOS GmbH	SP081430.030	Inner diameter:4.3 mm; Outer diameter:7.0 mm; Field angle: 80 °; Visual angle: 30 °; Working length: 181 mm
Endoscope system	SPINENDOS GmbH	SP082628.351	Φ2.5 mm × 310 mm
Endoscopic forceps	SPINENDOS GmbH	SP082700.040L	Φ4.0 mm × 360 mm
Endoscopic hook	XIYI	MQZ	Φ3.2 mm × 328 mm
Endoscopic rongeur	ELLIQUENCE	DTF-40	40 cm
etomidate	SPINENDOS GmbH	SP082781.835	Φ2.5 mm × 330 mm
High-speed burr	Neusoft Corporation
Interventional radiology	Ferrosan Medical Devices A/S	MS0010
iodine	Sichuan Guona Technology Co.,LTD	NNBP/40D/
Neusoft PACS/RIS	Elliquence, LLC	DTF-40
n-HA/PA66	SPINENDOS GmbH	SP082615.265	Φ7.2 mm × 178 mm
sufentanil citrate injection
SURGIFLO Haemostatic Matrix
Trigger-Flex Bipolar System
Working sheath