Endoscopic cervical disc surgery is an extraordinary alternative to conventional disc surgery, because it is less traumatic.

1. Spine center Berlin
Center of excellence for endoscopic
& minimal invasive spine surgery
Full endoscopic cervical foraminotomy for the
removal of lateral disc herniations
Christian Woiciechowsky
christian@woiciechowsky.de
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2. Operative strategies for cervical disc herniations
ventral
dorsal
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3. Different options for intervertebral space
implants
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4. Foraminotomy an alternative for lateral disc
herniations
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5. The neck muscels
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6. The neck muscels
Posterior Cervical Inclinatory Foraminotomy for Spondylotic Radiculopathy Preliminary
Jae-Chil Chang, M.D., Ph.D., Hyung-Ki Park, M.D., Ph.D., Soon-Kwan Choi, M.D., Ph.D.
Department of Neurosurgery, College of Medicine, Soonchunhyang University, Seoul, Korea
J Korean Neurosurg Soc 49 : 308-313, 2011
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7. The advantages and disadvantages for the ventral and
dorsal dorsal approach
Anterior approaches are extensive when compared to pathology,
 CAVE in the lumbar spine we always start with nerve decompression from
posterior and do not replace the whole disc. Same rules should be applied to
cerivical lateral disc herniation with radiculopathy.
Posterior approaches have risk of postoperative kyphosis, especially if the resection
of the facets was too extensive.
Postoperative neck pain caused by separation of access-related muscle attachments.
Goals
Less resection of the facetts
Less manipulation of the muscels
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8. The development of minimally invasive spine
surgery
OR-lights headlamp microscop endoscop
Two things are essential → Lights und magnification
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9. The importance of light
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10. The cervical endoscopic foraminotomy
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11. The cervical endoscopic foraminotomy
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12. The cervical endoscopic foraminotomy
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13. The cervical endoscopic foraminotomy
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14. The cervical endoscopic foraminotomy
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15. The cervical endoscopic foraminotomy
Good Indikation - Borderline-Indikation - Kontraindikation
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16. The cervical endoscopic foraminotomy
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17. Summary
Surgery should be adopted to anatpmy and pathology
Main decision criterion should be: best soulution for the problem not
application of a specific method which sounds attractive to the patient, e.g.
fusion versus artificial disc, ventral versus dorsal approach.
Cave possible complications, maybe higher, when starting with endoscopy
Cave problems with ventral surgery
 Risk of pseudarthrosis in fusion surgery
 Ektopic ossifikation in prosthesis surgery (risk 30-40%)
The length of skin incision should not be the only criterion for quality .
However changes in the depth are important:
 Muscle dettachment
 Bleeding, swelling
 Pressure of the spatula to the muscles→ hypoxia → edema → atrophy
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