Full endoscopic surgery of the cervical spine is done in select centers where
the clinical and surgical expertise is high. The procedure can be potentially dangerous
in less well-trained hands, with the prospect of damage to vital vascular structures, and
injury to the trachea, esophagus, cervical nerve roots, and the spinal cord. Also,
cervical endoscopy is competing with traditional spinal surgeries, such as anterior
cervical discectomy and fusion, or posterior cervical foraminotomy, whose clinical
outcomes are reliably favorable. Therefore, most surgeons have a hard time replacing
their well-performing anterior- or posterior cervical surgeries that they may very well
be carrying out through open or mini-open incision or other forms of minimally
invasive spinal surgery techniques. Patient satisfaction with these procedures is
generally very high, and the complication rate is relatively low, and their management
is well-understood. Again, is there a need for change? It is apparent that to the
innovators, the answer to this question is obviously “yes” because they are looking for
practical, yet less burdensome, lower cost, and more simplified outpatient cervical
spine surgeries. The general push by payors and patients to transition spine care from
in- to outpatient setting requires spine surgeons to rethink their approach to treating
common degenerative conditions of the cervical spine. New algorithms based on
updated classification systems and clinical outcome analysis of contemporary surgical
techniques are required to make this transition feasible. In this chapter, the authors
illustrate the application of full-endoscopic cervical spine surgery techniques, reviewing their indications, and the clinical decision-making by discussing the rationale for
the procedure of choice selection ranging from patient criteria, anatomical
considerations, surgeon training-, and skill level. This chapter is intended to serve as a
guide for the established spine surgeons who are yet inexperienced with endoscopy and
evaluates whether full endoscopy of the cervical spine should be in their
armamentarium.
Keywords: Cervical endoscopy, Cervical herniated disc, Cervical stenosis,
Clinical decision making algorithms, Myelopathy.
