Arthroscopic Anterior Diskectomy of the Cervical Spine

We describe a minimally invasive arthroscopic technique for anterior diskectomy of the cervical spine. Fingertip pressure is applied between the carotid sheath laterally and the pharynx medially. The trachea and esophagus are displaced to the contralateral side. The disk level, soft-tissue thickness, and midline are verified with image intensification. A spinal needle is inserted through the soft tissue into the disk space at the midline. Contrast is injected to facilitate visualization. While maintaining displacement of the pharynx, a 4-mm vertical incision is made to incorporate the needle and is enlarged bluntly. A guidewire is passed through the needle. A dilator is passed over the guidewire, through the soft tissue, and usually into the disk, stopping posterior to the mid-vertebral body, as verified with lateral imaging. A cannula is placed over the dilator, and the dilator and wire are removed. Occasionally, the cannula is passed over the dilator to the anterior aspect of the disk, and the dilator is replaced with a trephine to penetrate the anterior spinal ligament, osteophytes, and annulus. The cannula seated in the middle of the disk allows diskectomy to commence with small rongeurs through the cannula, followed by a cervical spine arthroscope with a working channel. The arthroscope is removed, and further diskectomy is performed under fluoroscopic guidance with a motorized shaver and radiofrequency probe.