BACKGROUND CONTEXT: Anterior percutaneous endoscopic cervical discectomy (APECD) has become an advanced and beneficial procedure for cervical disc herniation, in which most of surgeons use the two-finger technique to create a safe window. But for the patient with a thick neck, there is not enough space for using the two-finger technique regarding to the narrow space between anterior structures, which may increase the risk of damaging nerves, structures and vessels. Therefore, this study advanced the finger guiding technique. Compared to two-finger technique, using “one-finger technique” will help easier to dissect the cervical anterior anatomic structures without injuring them. PURPOSE: Anterior PECD in thick neck is a challenging procedure. This study describes anterior percutaneous endoscopic cervical discectomy modified by finger guiding technique for thick neck patient in midline cervical disc herniation. STUDY DESIGN:A technical note. PATIENT SAMPLE:A 52-year-old thick neck woman, presented with axial neck pain and weakness of extremities for one year. On neurologic examination, tingling sensation and numbness were not obvious but the power of extremities was dramatically decreased at a level of 3/5. Hoffmann sign was positive in the bilateral hand. Magnetic resonance imaging (MRI) showed a huge herniation of the C5-C6 disc compressing the medial area of the spinal cord. Preoperative computer tomography myelography (CTM) detected C5-C6 disc herniation with partial calcification. The anterior trans-corporeal approach of PECD, through the vertebral body of C5 was performed to address the disc herniation at the C5-C6 levels. OUTCOME MEASURES:The axial neck pain was measured using the visual analog scale (VAS). METHODS: A modified Finger guiding technique, using the index finger helps to dissect through the neck muscles, trachea, esophagus, and arteries until it touches the anterior side wall of C5 vertebral body. In Anterior Percutaneous Endoscopic Cervical Discectomy, using finger guiding techniques to detect the target point and make a safe path way for thick neck patient. RESULTS:The operation was accomplished in 90minutes. Postoperatively the patient was advised to wear a neck collar for 3 weeks. Immediately after the operation, the axial neck pain improved from VAS 7/10 preoperatively to 3/10, and the range of motion was unrestricted. In the further follow-up, the patient had completely recovered from the symptoms and the postoperative MRI finding was not significant. The patient was advised for 3-month and longer follow-up. CONCLUSIONS:Compared to two-finger technique, one-finger technique is easier to dissect the cervical anterior anatomic structures without injury. However, as a limitation of one case shows, whether this modified PECD with one-finger guiding technique is efficacious and reliable should be verified in a further comparative cohort study with large numbers of cases.
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