13. Cervical disc herniation

Cervical intervertebral disc herniation may compress a nerve root and cause pain in the neck, arm, and scapular region, numbness, and muscle weakness. If conservative treatment is ineffective or a neurological deficit is present, we consider surgical decompression. Clinical manifestations must correspond to the level and nature of compression on MRI.

Anterior cervical discectomy and fusion (ACDF) is an established treatment. Fusion eliminates movement at the operated segment, while the anterior approach and implants carry specific risks. Posterior biportal endoscopic foraminotomy with discectomy allows nerve root decompression without fusion, an anterior neck approach, or implant placement.

We use the posterior BESS/UBE approach described in this chapter for lateral, foraminal, and selected paramedian herniations when nerve root compression corresponds to the clinical presentation and the fragment is accessible without spinal cord retraction. Central herniations requiring spinal cord decompression, instability requiring stabilization, and deformity requiring correction need a different surgical strategy. We determine the suitability of the approach from the combined clinical and imaging findings.

BESS/UBE uses separate endoscopic and working portals, allowing independent control of the endoscope and instruments. A wide field of view and familiar anatomical orientation facilitate the procedure, while the ability to use standard surgical instruments is a practical advantage of the technique. Biportal access combines freedom of manipulation with minimal trauma to muscles and soft tissues.

References

1. Jung SB, Kim N. Biportal endoscopic spine surgery for cervical disk herniation: a technical notes and preliminary report. Medicine (Baltimore). 2022;101(27):e29751. DOI: 10.1097/MD.0000000000029751.

2. Jung SB, Gunadala I, Kim N. Comparison of cervical biportal endoscopic spine surgery and anterior cervical discectomy and fusion in patients with symptomatic cervical disc herniation. J Clin Med. 2024;13(6):1823. DOI: 10.3390/jcm13061823.

3. Lee SH, Seo J, Jeong D, Hwang JS, Jang JW, Cho YE, et al. Clinical outcomes and complications of unilateral biportal endoscopic posterior cervical foraminotomy: a systematic review and meta-analysis with a comparison to full-endoscopic posterior cervical foraminotomy. Neurospine. 2024;21(3):807–819. DOI: 10.14245/ns.2448430.215.

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