A ground-breaking, new surgery

Endoscopic cervical fusion

Who is eligible for endoscopic cervical fusion surgery?

Cervical pain and/or radiated pain into the arms is caused in most cases by disk herniations and foraminal stenosis that can usually be solved by  endoscopic surgery. However, there are also cases for which it is necessary to place implants and disk spacers/cages into de cervical disk.  Endoscopic cervical spine fusion surgery is indicated for cases with more complex cervical pathologies, like cervical instability (spondilolysthesis), deformity of the cervical spine (kyphosis) and bialteral radiating arm pain.

CT Scan (right) and X-ray film (left) of a cervical spine with advanced degeneration of the cervical interbody disks (marked by a red circle)

Standard anterior cervical disk fusion (ACDF) surgery is performed with a big incision on the patient’s throat and an open dissection of the anatomic structures of the throat until reaching the cervical spine. Open dissection and resection of tissues around the cervica spine lead to bigger internal scar tissue, higher risk for infection and bleeding that could lead to forming a hematoma, which could occlude the air pipe (trachea) and lead the patient to suffocate. Hence, in most cases after open cervical spine surgery / ACDF the patient is moved to the Intensive Care Unit (ICU) for close-up monitoring, as open cervical spine surgery comes with many risks for the patient.

Post-operative X-rays showing an interbody cage at two separate cervical disks after endoscopic fusion surgery

Video of an endoscopic cervical fusion case of a 91 years-old woman

Video of a 91 years-old (!) patient who underwent a two-level endoscopic fusion surgery of the cervical spine and was discharged from the hospital in less than 24 hours after surgery

Endoscopic cervical fusion surgery

El Dr. Morgenstern es pionero mundial en la cirugía de fusión endoscópica cervical que permite la inserción de un implante en un disco intervertebral de la columna cervical mediante una incisión de menos de 2 cm de longitud en el cuello del paciente.

La cirugía endoscópica de fusión se realiza mediante dilatación progresiva de los tejidos blandos y no requiere la resección de estructuras anatómicas para poder acceder al disco cervical. De esta manera se reduce la cicatrización y el sangrado, reduciendo los riesgos de infección, hematoma, etc. hasta tal punto que la cirugía de fusión endoscópica cervical NO requiere ingreso en UCI y puede darse el alta hospitalaria al paciente en menos de 24 horas tras la cirugía.

Mínima cicatriz en el cuello de una paciente tras cirugía de fusión endoscópica cervical con la inserción de DOS cajas por la misma pequeña cicatriz en el cuello

La cirugía de fusión endoscópica se inicia con una discectomía endoscópica para la preparación del disco. Una vez el disco se ha preparado, se procede a la inserción percutánea del implante, pudiendo ser este una caja intersomática para la fusión vertebral o una prótesis de disco para conservar la movilidad del nivel operado. La inserción del implante se realiza mediante control fluoroscópico y visión endoscópica directa, véase la animación en el lateral derecho de esta página.

Rx en frente (izquierda) y perfil (derecha) de un implante/caja intersomática de titanio insertada mediante técnica endoscópica en el nivel C5/C6

El dolor de origen de la patología suele remitir en las primeras horas tras expandir el espacio intervertebral. Deambulación inmediata y alta hospitalaria en menos de 24 horas.

Clinical case example

This 49 years-old patient presented with a migrated cervical herniation at level C4/C5 and an unstable disk at C5/C6. En endoscopic cervical decompression was performed to remove the herniation and two intervertebral cages were placed endoscopically using a a skin incision of just 2 cm length. Post-operatively, the patient recovered very quickly and was discharged from the hospital within a day after surgery

Click on the arrows on the left and right side of the image to scroll through all the cases’ pictures.

Animation showing the endoscopic placement of a cage into a cervical disk

Animated image showing the endoscopic insertion of an intervertebral cage into a cervical disk. Note the distraction of the disk space during as the cage is inserted.

Minimal skin incision of only 2 cm length after the placemente of 2 cervical intervertebral cages in the cervica spine using the endoscopic fusion technique.

© Copyright – Morgenstern Institute of Spine, 2019.