The Current State of Cervical Endoscopic Spine Surgery: an Updated Literature Review and Technical Considerations

ABSTRACT

Introduction: Endoscopic spine surgery has become one of the representative minimally invasive spine surgeries (MISS), especially in the lumbar spine. Full-endoscopic procedures using a working channel endoscope for cervical degenerative spine disease have been reported as practical and feasible. This review aimed to summarize the updated techniques of and studies about cervical endoscopic surgery.

Areas covered: An extensive search of PubMed was performed for randomized controlled trials (RCTs) or comparative cohort studies on the full-endoscopic cervical procedure. All the 236 articles found were screened and categorized. Only two RCTs and four cohort studies finally met the search criteria. Regarding the surgical techniques, there are four categories according to the approach method: 1) anterior endoscopic cervical discectomy (AECD); 2) anterior endoscopic cervical transcorporeal decompression (AECTcD); 3) posterior endoscopic cervical foraminotomy and discectomy (PECFD); and 4) posterior endoscopic cervical laminotomy (PECL).

Expert opinion: Cervical endoscopic surgery provides comparable clinical results with MISS benefits, such as shorter operative time, less bleeding, and earlier recovery time. However, spine surgeons are not yet familiar with most of these techniques; moreover, supportive evidence is minimal. Technical evolution is still ongoing in an effort to make the procedure more practical.

KEYWORDS:

• Cervical
• discectomy
• endoscopic
• foraminotomy
• laminotomy
• working channel endoscope

Article highlights

• Cervical endoscopic spine surgery using a working channel endoscope is regarded as an excellent alternative to the standard open surgery.• The full-endoscopic cervical procedures can be categorized into four methods according to the direction and access window.• Anterior endoscopic cervical discectomy is the first developed and a representative endoscopic cervical procedure.• Anterior endoscopic transcorporeal decompression is a promising technique with preserving the maternal disc space.• Posterior endoscopic cervical foraminotomy and discectomy is the most studied and effective posterior endoscopic decompression technique.• Posterior endoscopic cervical laminotomy can treat cervical spondylotic myelopathy as well as cervical radiculopathy.• The level of evidence of the full-endoscopic cervical procedures is low, with two randomized controlled trials and four comparative cohort studies.• Technical unfamiliarity or a long learning curve is still the main entry barrier to cervical endoscopic surgery.• Technological developments in optics, devices, and approach methods will make the endoscopic procedure popular and practical.

Acknowledgments

The author would like to thank Hwa-young Kim and Je-min Son for their valuable supports.

Disclosure statement

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

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Funding

This paper is not funded.