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20

1. Cervical percutaneous laser disc decompression:

preliminary results of an ongoing prospective outcome
study.
Source
The Spinal Foundation, Rochdale, UK. mknight@spinalfound.u-net.com

Abstract
OBJECTIVE:
This study identifies the efficacy of laser disc ablation and compares the relative
efficacy of Holmium2100; YAG and KTP532 laser wavelengths in the treatment of
broad-based cervical disc protrusions presenting with cervical axial pain with
compressive or noncompressive radicular symptoms.
BACKGROUND:
A preliminary report on a prospective outcome study of cervical laser disc ablation and
decompression in the management of cervical disc prolapse and discographically
confirmed discogenic pain in association with radicular pain.
METHODS:
Patients with chronic cervical pain and radicular symptoms unresponsive to
conservative treatment were assessed with magnetic resonance (MR) scans. Those with
broad-based disc bulge or discal degeneration were assessed with provocative
discography to isolate the source of pain. Percutaneous laser disc decompression was
performed as a day case procedure on 105 patients at 108 levels under X-ray control via
the anterior approach with side-firing probes in patients.
RESULTS:
At a minimum follow up of 24 months, 51% of patients demonstrated a sustained
significant clinical benefit with an additional 25% in whom functional improvement was
noted. No difference in outcome was identified either with the wavelengths used or with
laser annealing or painful discal tears. The cohort integrity of the study was 80%.
CONCLUSION:
The sustained nature of the benefit (mean 3.5 years at final follow up) after long-term
preoperative symptoms (mean 3.9 years) in 76% patients rules out placebo effect.
Benefits occurred independently of the wavelength of laser used.

21

2. Chronic cervical pain: radiculopathy or brachialgia.

Noninterventional treatment.
Source
University of Miami Comprehensive Pain and Rehabilitation Center, Miami Beach,
Florida.

Abstract
Chronic cervical pain is not always attributable to radiculopathy. Pain may derive
from peripheral myofascial syndromes and/or central inflammatory root irritation from
degradation of discal proteoglycans. This concept is presented with its application in 30
patients with follow-up observations up to 30 months. Twelve of twenty-five achieving a
pain level of 0 (out of a possible 10), ten of twenty-five had a pain level of 2, and three of
twenty-five had a pain level of 4. Five cases were considered to be failures because of
patient noncompliance. Treatment was multidisciplinary: aggressive physical medicine,
behavioral medicine, vocational, and recreational rehabilitation with the goal of a return
to socioeconomic productivity or previous lifestyle, secondary to which pain relief or
control follows. Emphasis was placed on the restoration of musculoskeletal physiology to
normal with behavioral modification, good body mechanics and the application of
engineering/ergonomic principles at work or recreation.

3. Percutaneous techniques for cervical pain of discal origin.

Source
Department of Non-Vascular Interventional Radiology, University Hospital, University
of Strasbourg, Strasbourg, France. gangi@rad6.u-strasbg.fr

Abstract
Cervical discogenic pain is an important cause of suffering and disability in the adult
population. Pain management in cervical disc herniation relies initially on conservative
care (rest, physiotherapy, and oral medications). Once conservative treatment has failed,
different percutaneous minimally invasive radiological procedures can be applied to relief
pain. This article offers a systematic review on the percutaneous minimally invasive
techniques that can be advocated for the treatment of cervical pain of discal origin.
Periradicular steroid injection under image guidance (computed tomography or magnetic
resonance imaging) is the first technique to be considered. The steroid injection aims at
reducing the periradicular inflammation and thus relieves the radicular pain. The steroid
injections present satisfying short-term results, but pain can recur in the long term.
Whenever the steroid injections fail to relieve pain from a contained cervical disc
22

herniation, the more invasive percutaneous disc decompression techniques should be

proposed. Percutaneous radiofrequency nucleoplasty is the most often applied technique
on the cervical level with a low risk of thermal damage. When the indications and
instructions are respected, radiofrequency nucleoplasty presents accepted safety and
efficacy levels.

4. Percutaneous cervical disc decompression.

Source
Orthopaedic Clinic Hennef/Sieg, Hennef, Germany. drbirnbaum@web.de

Abstract
BACKGROUND:
Cervical disc nucleoplasty is a significant and clinically demonstrated innovation
in percutaneous disc decompression in case of non-herniated disc protrusions or prolpase.
It allows a percutaneous decompression via a 19-gauge needle under utilization of the
Coblation technique and under C-arm control. Until now the patients suffering of a
cervicobrachialgia in cause of a disc prolapse had only the therapeutical solution between
conservative treatment and monosegmental spondylodesis or disc prosthesis of the
mentioned motion segment.
METHODS:
We wanted to demonstrate a new and practicable anatomical pathway for
reaching the cervical disc prolapse comparable to the technique for discography of the
cervical spine. The introducer needle is advanced into the disc under fluoroscopic
guidance using a standard anterior-lateral approach. The controller delivers
radiofrequency energy to quickly ablate tissue at temperatures between 50 degrees and 60
degrees C. The decompression will be done in ablation mode by rotating the device
through 180 degrees for 5 s in the posterior, medial and ventral third of the cervical disc.
After failed conservative treatment over an average time period of 3 months we treated
26 patients with a contained herniated prolapse or protrusion with radicular arm pain by
percutaneous decompression under utilization of the Coblation technique with a
controlled energy plasma-mediated field. A randomized control group of 30 patients was
treated alone conservatively with medical and physical therapy in the same period.

23

RESULTS:
The average preoperative VAS was 8.8. With a follow-up time of 2-years we
found an average pain reduction with the visual pain score (VAS) of 2.3 who had a
further check-up. The VAS was checked 24 h, 1 week, 3, 6, 12 and 24 months
postoperatively. No complications with this method were seen. Comparable to the
surgically treated group the conservative patients have had a VAS of 8.4. Under using
conservative treatment with physical therapy, physiotherapy, analgetics and perineural
injections we have had a diminution of the VAS to 5.1 after 2 years.
CONCLUSION:
The percutaneous decompression of the cervical disc protrusion with the Perc DCSpine Wand by using the Coblation mode is a quick and safe procedure. Furthermore,
one may state a persistent pain relief in the follow-up time up to 2 years after the
percutaneous decompression of the disc.

5. Long term outcome of anterior cervical discectomy and

fusion using coral grafts.
Source
Department of Neurosurgery, Cliniques Universitaires St-Luc, Universit
Catholique de Louvain, 10 Avenue Hippocrate, 1200 Brussels, Belgium.

Abstract
BACKGROUND:
To determine the long term efficacy of coral grafts in anterior cervical discectomy and
fusion.
METHODS:
In this prospective longitudinal study, All patients presenting with myelopathy
and/or radiculopathy due to discal hernia or cervical spondylosis underwent anterior
cervical microdiscectomy, arthrodesis with coral, and stabilization with anterior cervical
locking plates. Clinical and radiological post-operative evaluations were performed at 2
days, 3, 6, and 12 months, and then yearly. The visual analogue scale was used for the
evaluation of pain. Fusion was defined as the absence of motion on dynamic imaging
combined with the disappearance of radio-lucent lines around the graft. The mean followup period was 44 months. In 83.3%, 91.2% and 93.7% of patients there was a satisfactory
outcome for neck pain, arm pain, and motor deficit, respectively. The overall

24

complication rate was 17.5%, all of which were transient. Additional surgery was
required in nine cases. The occurrence of complications is correlated with less
satisfactory outcomes for both neck and arm pain. While 95.5% of patients expressed
overall satisfaction with their surgery, 70.5% stated that they had returned to their
previous activities. The fusion rate was 45%; which was not correlated with clinical
outcome and more likely in patients with of cervical spondylosis and one-level
arthrodesis.
CONCLUSIONS:
Despite satisfactory clinical results and a long follow-up period, coral implants
yield low fusion rates, particularly in patients with discal hernia of two-level arthrodesis.
The use of coral grafts cannot be recommended when fusion is one of the post-operative
endpoints.

6. Clinical application of lower cervical spinous process

laminar screw technique in open door laminoplasty.
Source
Department of Spinal Surgery, Ningbo No. 6 Hospital, Ningbo 315040, Zhejiang, China.

Abstract
OBJECTIVE:
To investigate the clinical outcomes of lower cervical spinous process laminar
screw technique in open door laminoplasty.
METHODS:
From February 2005 to June 2010,12 patients with cervical myelopathy were
treated with open door laminoplasty by lower cervical spinous process laminar screw
technique. There was intervertebral disc herniation with degenerative stenosis in 5
patients, ossification of posterior longitudinal ligament with osteophyte in 6 patients,
cervical traumatic instability with spinal cord injuries in 1 patient. Nerve function,
complications, and the cervical canal to body ratio (CBR), range of motion (ROM) and
the anteroposterior serial alignment were observed by Japanese Orthopedic Association
(JOA) score, X-ray, CT and MRI.

25

RESULTS:
The surgical time was from 1.5 to 2 h with an average of 110 min; blood loss
during operation was from 450 to 800 ml with an average of 580 ml. Postoperative
complication occurred in 1 case with upper limb pain and 1 case with cerebrospinal fluid
leakage. All patients were followed up from 1 to 2 years with an average of 21.8 months.
JOA score improved from preoperative 9.5 +/- 1.8 to postoperative 13.6 +/- 2.4 (P <
0.01). X-ray, CT, MRI showed CBR increased obviously (P < 0.01); ROM on flexionextension and cervical lordosis decreased respectively from (40.0 +/- 10.0) degrees and
(65.0 +/- 12.0)% before operation to (15.0 +/- 5.0) degrees and (42.0 +/- 8.0) % at the
final follow-up (P < 0.01).
CONCLUSION:
Lower cervical spinous process laminar screw technique in open door
laminoplasty for cervical syndrome is safe and can obtain satisfactory effects, has strong
internal fixation and reduce the risk of re-closure.

26

7. Cervical Deuk Laser Disc Repair(): A novel, fullendoscopic surgical technique for the treatment of
symptomatic cervical disc disease.
Source
Deuk Spine Foundation, Deuk Spine Institute, Melbourne, Florida.

Abstract
BACKGROUND:
Cervical Deuk Laser Disc Repair() is a novel full-endoscopic, anterior cervical,
trans-discal, motion preserving, laser assisted, nonfusion, outpatient surgical procedure to
safely treat symptomatic cervical disc diseases including herniation, spondylosis,
stenosis, and annular tears. Here we describe a new endoscopic approach to cervical disc
disease that allows direct visualization of the posterior longitudinal ligament, posterior
vertebral endplates, annulus, neuroforamina, and herniated disc fragments. All patients
treated with Deuk Laser Disc Repair were also candidates for anterior cervical
discectomy and fusion (ACDF).
METHODS:
A total of 142 consecutive adult patients with symptomatic cervical disc disease
underwent Deuk Laser Disc Repair during a 4-year period. This novel procedure
incorporates a full-endoscopic selective partial decompressive discectomy,
foraminoplasty, and posterior annular debridement. Postoperative complications and
average volume of herniated disc fragments removed are reported.
RESULTS:
All patients were successfully treated with cervical Deuk Laser Disc Repair.
There were no postoperative complications. Average volume of herniated disc material
removed was 0.09 ml.
CONCLUSIONS:
Potential benefits of Deuk Laser Disc Repair for symptomatic cervical disc
disease include lower cost, smaller incision, nonfusion, preservation of segmental motion,
outpatient, faster recovery, less postoperative analgesic use, fewer complications, no
hardware failure, no pseudoarthrosis, no postoperative dysphagia, and no increased risk
of adjacent segment disease as seen with fusion.

27

(a) Lateral intraoperative fluoroscopic image during cervical chromodiscography

demonstrates C5-6 posterior annular tear with interposed disc material (arrow). (b)
Intraoperative endoscopic image and (c) drawing demonstrate posterior annulus (An)
with tear (arrows) and collagenized herniated nucleus pulposus (interposed disc, ID).
Rostral (Ro) and caudal (Ca) endplates are visible

(a) Intraoperative photograph demonstrating anterior cervical approach and endoscope

rigged with camera, laser fiber, irrigation and suction. (b) Endoscopic trans-discal view
of the posterior disc shows laser fiber (1), herniated disc fragments (HD), rostral (Ro)
and caudal (Co) endplates and dura of the lateral spinal cord (4). (c) Normal foraminal
anatomy after Deuk Laser Disc Repair. Herniated disc fragments have been removed
endoscopically to reveal a decompressed foramen (3) and dura of the lateral spinal cord
(4). The base of the uncinate process (2) is visible through the cannula (7). Also seen is
the lateral border of the posterior longitudinal ligament (5) and debrided posterior
annulus (6)

28

(a)
Lateral intraoperative fluoroscopic image demonstrates the use
of surgical graspers through the cannula to aid in the removal of
herniated disc fragments endoscopically released by Holmium-YAG
laser. (b) Photograph of grasper with cervical disc fragment

Photograph of multiple fragments of herniated disc material collected

after removal during endoscopic cervical Deuk Laser Disc Repair

29

8. Surgical outcome of anterior decompression in cervical

spondylotic myelopathy in patients with less cord
derangement.
Source
Department of Neurosurgery, Loghman Hakim Hospital, Shahid Beheshti University of
Medical SciencesTehran, Iran - ehsanalavi1978@yahoo.com.

Abstract
AIM:
CSM patients caused by osteophytic ridge or intervertebral disc herniation
underwent anterior decompression and fusion were prospectively enrolled. The purpose
was to elucidate the effects of decompression (anterior cervical discectomy and fusion)
on myelopathic cord in milder cases, younger patients, and in short duration of the
disease.
METHODS:
Forty-three patients with CSM were examined comprising Cooper and mJOA
scale before and after surgery and followed for 12 months.
RESULTS:
Patients included in the study were 30 males and 13 females. The mean age of
men was 50.913.2, and that of women was 46.811.8. The mean interval from
symptoms onset to hospital presentation was 10.787.3 months. In lower limbs, among
31 with preoperative functional impairment, 25 remained unchanged, three improved and
three worsened, which is not significant, and of 39 patients with preoperative upper limb
functional impairments using Cooper's scale, 20 improved, 15 remained unchanged and 4
became worse (P=0.001). Recovery rate for mJOA score was 24.517.7%, for Cooper
lower extremity score was 32.240.56% and for Cooper upper extremity score was
7.816.8%. The mean gain in mJOA was 0.84 (0.57).
CONCLUSION:
Patients with short duration of symptom onset respond remarkably to
decompression surgery. In patients with good condition that myelopathy has not
established yet, perhaps mJOA is not a perfect and powerful scale for pre and
postoperative assessment of patient.

30

9. Laterality of cervical disc herniation.

Source
Department of Spine and Spinal Surgery, Shinkomonji Hospital, 2-5, Dairishinmachi,
Moji, Kitakyushu, Fukuoka, 800-0057, Japan, yuichi5356@yahoo.co.jp.

Abstract
PURPOSE:
Cervical disc herniation (CDH) is found more frequently at the lower cervical
spine than at the upper or middle level. However, there is scarcity of data about the
laterality of CDH. The aim of this study is to detect the laterality of CDH.
METHODS:
We retrospectively evaluated preoperative computed tomography myelograms
and magnetic resonance images of 75 cases of CDH who underwent single level anterior
cervical discectomy and fusion at C4-5, C5-6, or C6-7 levels from 2008 to 2010 in our
institute. Statistical analyses were performed using the Chi-square test.
RESULTS:
Eleven cases were found at C4-5 level, 42 cases at C5-6 level, and 22 cases at C67 level. At C4-5 level, CDH was recognized at the right side in 2 cases, at the left side in
2 cases, and at the center in 7 cases. At C5-6 level, CDH was found at the right side in 20
cases and at the left side in 22 cases. At C6-7 level, CDH was found at the right side in 3
cases and at the left side in 19 cases with significantly high frequency of left-sided CDH
(p < 0.025).
CONCLUSIONS:
In this study, it was revealed that the left-sided CDH was more frequent than the
right-sided CDH at C6-7 level.

4.1
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110 , 73 ,
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. - 1999
J. Paladino Ljeniki dnevnik 11.2011
D-r Olga Popovi Mladenovi Klinika primena fizikalne medicine
Beograd 2010

4.

Prof. dr eljko Kojadinovi Neurohirurg internet blog: Bol u kimenom stubu.

34