Percutaneous Endoscopic Cervical Discectomy: Surgical Approaches and Postoperative Imaging Changes

STUDY DESIGN: Retrospective clinical study. PURPOSE: This study investigated the relationship between surgical approaches and surgical outcomes in patients undergoing percutaneous endoscopic cervical discectomy (PECD), including the reduction in intervertebral disc height and the incidence of Modic changes. OVERVIEW OF LITERATURE: The anterior approach involves partial invasion of the intervertebral disc, with a reported reduction in intervertebral disc height after PECD. METHODS: Forty-two patients with cervical disk hernia who underwent PECD and magnetic resonance imaging at least 3 months postoperatively were divided into four groups according to the hernia sites and the surgical approach used: unilateral hernia treated using the contralateral approach (group C, n=18), unilateral hernia treated using the ipsilateral approach (group I, n=15), midline hernia (group M, n=4), and broad and bilateral hernia (group B, n=5). Modic changes and intervertebral disc height were evaluated. RESULTS: The overall incidence of Modic changes was 52.4%: 72.2% in group C, 26.7% in group I, 25.0% in group M, and 80.0% in group B. The reduction in intervertebral disc height was 21.8% across all the patients: 24.5% in group C, 11.0% in group I, 22.8% in group M, and 23.9% in group B. CONCLUSIONS: The incidence of Modic changes and the reduction in intervertebral disc height were lower in the patients treated using the ipsilateral approach than in those treated using the contralateral approach. Traditionally, a contralateral approach has been used for PECD; however, the ipsilateral approach is more appropriate and is therefore recommended.