Cervical disk surgery - percutaneous disk removal

Percutaneous nucleotomy of the cervical spine

As opposed to other common surgical procedures, where the entire disk is removed and replaced by a placeholder (cage or artificial replacement), with this special method only the herniated material is removed under local anesthesia. The natural mobility and stability of the cervical spine is maintained.

In fact, this surgical procedure is analogous to the discectomy of the lumbar spine where also only the herniated tissue is removed and not the entire disk replaced by an artificial placeholder. 

This revolutionary surgical technique is practiced almost exclusively by Dr. Schubert.

Percutaneous discectomy

If severe pain and neurological symptoms cannot be controlled with conservative treatment a surgical intervention will be indicated. Aim of the discectomy is to remove the extruded disk tissue and to decompress or to completely set free the pinched nerve. For a long time the fusion of the affected segment was the “gold standard” treatment for a herniated disk of the cervical spine. However, this is a procedure that implies open surgery and leads to a permanent loss of mobility of the affected segment.

Percutaneous nucleotomy is a low risk alternative to open surgery that provides decompression of the nerves without the necessity of opening the spinal canal or stiffening of the affected segment.

By this means the delicate neural structures are preserved and overwork of the adjacent spinal disks – which is a common long-term consequence of a stiffening surgery - can be prevented. As all in all only very little tissue has to be removed there is generally almost no scarring in the surgical field.

This technique must not be mixed up with other so called “percutaneous procedures”. Although it may sound quite similar the approach is largely different: Healthy tissue from the core of the spinal disk is shrunk by heat or withdrawn by suction assuming that the herniation will then retract.

Percutaneous nucleotomy, however, is a technique where under x-ray control especially developed instruments will be brought exactly to the place where the prolapsed disk material pinches the nerve. Only the herniated tissue will be removed; the healthy parts will remain untouched!  

How is surgery carried out? 

At first, under local anesthesia and x-ray control a thin probe will be inserted into the affected spine segment. Via the probe special minute instruments will then be carefully pushed forward to the herniation. With little forceps the protruding disk tissue can be removed very precisely.

 

The effect: The compressed nerve root is freed, so that pain will immediately be relieved. In some cases it may be necessary to shrink the jelly nucleus with the aid of an enzyme (chymopapain) to enhance the healing process of the fibrous ring of the spinal disk. 

The intervention will take 30 to 45 minutes. 

The next day there will be a follow-up examination and you will be discharged home. After three months there will be another clinical x-ray examination. 

Percutaneous disk surgery in the cervical spine - modified foraminotomy 

This surgery is done from the back. The dorsal cervical microforaminotomy (Frykholm surgery) is a tissue preserving and very safe procedure.

It is an effective alternative to the standard ventral discectomy with fusion or artificial disk replacement especially in cases of a soft lateral sequester or a purely lateral foraminal stenosis.

The additional use of an endoscope may be helpful in those cases. This dorsal percutaneous discectomy has a high success rate in appropriately selected patients.

As opposed to other common surgical procedures, where the entire disk is removed and replaced by a placeholder (cage or artificial replacement), with this special method only the herniated material is removed under local anesthesia. The natural mobility and stability of the cervical spine is maintained.

 

What postoperative care is necessary?

You should rest during the first week; carrying a neck brace, however, is not necessary. About one week after the intervention, it is recommended to start an individually targeted and professionally supervised physiotherapy.

When may I resume my sports activities?

About three weeks after surgery you should be able to go swimming or to ride your bicycle regularly. Your may gradually resume your usual sports activities approximately 6 weeks after the intervention.

When can I go back to work?

After one to two weeks you can resume simple office work and slight physical work. You shouldn’t do any hard physical work during the first 6 weeks and then only gradually increase.

What is the success rate? 

According to our own investigations and other clinical study data the success rate is more than 90%. 

At a glance! 

 

The most important facts at a glance for your convenience

 

Conventional open disc surgery

Endoscopic disc surgery

Anesthesia

Patient is in full anesthesia. Danger of nerve damage from surgery.

Surgery is carried out in local anesthesia and concomitant sedation. The patient is under constant surveillance. Nerve damages are hence virtually excluded.

Positioning

Patient is in supine position with the neck extended and surgery is done through a 4-8 cm incision.

Patient is supine with the neck in a comfortable position. The surgery is carried out through a 3mm wide skin incision.

Risks

  • After surgery the vertebral bodies are fused
  • increased risk of scarring and adhesions around the nerves (cause of pain?)
  • high risk that also healthy disk tissue is damaged or removed
  • neighboring segments are overstressed with a risk of instability or degeneration

  • There is only very little growth of scar tissue and adhesions
  • Only the prolapsed disc tissue is removed.
  • The recurrence risk is at about 8%
  • there are no instabilities after surgery

Pain

Pain is relatively severe after surgery.

There is no or only very little pain after surgery.

 

After the intervention

As a rule return to full activity takes 6 weeks.

Two hours after surgery you can leave the recovery unit by yourself.

 

Hospital stay

1 to 3 weeks. Eventually a hospital stay is required already before surgery.

1-2 days.

Surgery

 

Depending on the surgical technique healthy structures are destroyed to a varying degree. An additional intervention at the iliac crest may be required for harvesting bone material. During this fusion plates will be inserted and fixed with screws in the respective segments.

Loss of mobility as well as severe trauma with resulting pain are the consequences.

 

 

The surgeon only removes the disturbing disc tissue without damaging or removing surrounding structures like bones,  ligaments or muscles. Hence an instability or the growth of scar tissue around the nerve is prevented.

 

 

 

Sports

Resuming sports is possible only after 4 to 6 weeks.

Resuming sports is possible already after 2 weeks.

Schedules

Long waiting times are not unusual.

In acute cases you can be operated on within 48 hours.

 

 

!!! Mobility and function of the spine are completely preserved !!!

All advantages at a glance:
  • very low infection rate < 0,01%
  • Due to this minimally invasive intervention, the natural stability and mobility of the spinal disk (the motion segment) is fully maintained.
  • As there is almost no tissue damage, the intervention is less cumbersome and the risk of complications is very low
  • The intervention is carried out under local anesthesia
  • Short hospital stay: you can go back home the day after the intervention. If desired you may be treated also on an outpatient base, so that you can leave the clinic the same day.
  • Already after a few days you may resume your usual daily activities
  • Short recovery times: after one or two weeks you can go back to work, after 6 weeks you may resume your usual sports activities.
  • The intervention leaves almost no scarring
  • Success rates are at about 90% according to our own statistical evaluations

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Reviews

I needed to tell just one sentence and diagnosis was established and then also confirmed by imaging techniques. Neither the orthopedic specialist nor the radiologist I had visited before, had identified the herniated disc. They told me to do some sports and that surgery would not help. Immediately after the surgery in the ATOS clinic, my symptoms disappeared and I was also pain free. Absolute number 1 address for spinal disc problems.

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