- Deuk Spine Foundation, Melbourne, Florida, USA
Ara J. Deukmedjian
Deuk Spine Foundation, Melbourne, Florida, USA
DOI:10.4103/2152-7806.112610Copyright: © 2013 Deukmedjian AJ This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
How to cite this article: Deukmedjian AJ, Jason Cutright ST, Cianciabella PA, Deukmedjian A. Deuk Laser Disc Repair® is a safe and effective treatment for symptomatic cervical disc disease. Surg Neurol Int 28-May-2013;4:68
How to cite this URL: Deukmedjian AJ, Jason Cutright ST, Cianciabella PA, Deukmedjian A. Deuk Laser Disc Repair® is a safe and effective treatment for symptomatic cervical disc disease. Surg Neurol Int 28-May-2013;4:68. Available from: http://sni.wpengine.com/surgicalint_articles/deuk-laser-disc-repair-is-a-safe-and-effective-treatment-for-symptomatic-cervical-disc-disease/
Background:Deuk Laser Disc Repair® is a new full-endoscopic surgical procedure to repair symptomatic cervical disc disease.
Methods:A prospective cohort of 66 consecutive patients underwent cervical Deuk Laser Disc Repair® for one (n = 21) or two adjacent (n = 45) symptomatic levels of cervical disc disease and were evaluated postoperatively for resolution of headache, neck pain, arm pain, and radicular symptoms. All patients were candidates for anterior cervical discectomy and fusion (ACDF) or arthroplasty. The Mann–Whitney Wilcoxon test was used to calculate P values.
Results:All patients (n = 66) had significant improvement in preoperative symptoms with an average symptom resolution of 94.6%. Fifty percent (n = 33) had 100% resolution of all preoperative cervicogenic symptoms. Only 4.5% (n = 3) had less than 80% resolution of preoperative symptoms. Visual analog scale (VAS) significantly improved from 8.7 preoperatively to 0.5 postoperatively (P P = 0.111) in patients with n = 52) or >90 days (n = 14, mean 319 days) follow-up. No significant difference in outcomes was observed (P = 0.774) for patients undergoing one or two level Deuk Laser Disc Repair®. Patients diagnosed with postoperative cervical facet syndrome did significantly worse (P
Conclusion:Deuk Laser Disc Repair® is a safe and effective alternative to ACDF or arthroplasty for the treatment of one or two adjacent symptomatic cervical disc herniations with an overall success rate of 94.6%.
Keywords: Cervical radiculopathy, Deuk Laser Disc Repair, endoscopic spine surgery, intervertebral disc degeneration, intervertebral disc displacement, minimally invasive spine surgery
Cervical disc diseases, including annular tears, disc bulges, contained and noncontained disc herniations, disc osteophyte complexes, degenerative disc disease, spondylosis, and stenosis are common and frequently symptomatic.[
Deuk Laser Disc Repair® is a new minimally invasive, motion preserving, outpatient surgical procedure to endoscopically repair symptomatic cervical discs without fusion, implants, or biologics. The Deuk Laser Disc Repair® surgical technique has been previously described[
From 2008 to 2011, 66 consecutive patients meeting inclusion criteria with one (n = 21) or two (n = 45) adjacent symptomatic cervical disc(s) underwent surgical treatment with Deuk Laser Disc Repair® at their symptomatic level(s). Total number of cervical levels treated for the cohort was 111 or 1.7 levels per patient [
All patients aged 18 years or older undergoing Deuk Laser Disc Repair® with only one or two adjacent levels of symptomatic cervical disc disease that failed standard conservative treatments were included in this study. All patients had preoperative symptoms attributable to either one or two diseased cervical discs. Symptoms included one or more of the following: Neck pain, arm pain, cervicogenic headache, or upper extremity radicular symptoms [
Emphasis was placed on patient reported outcome measures including visual analog scale (VAS) and resolution of preoperative pain and radicular symptoms. Resolution of preoperative neck pain, arm pain, headache, and radicular symptoms for each patient treated was recorded by a medical assistant as a percentage from 0% to 100%. Operative time and recovery time were measured in minutes for each patient. Recovery time was the period from extubation to discharge home from the facility. Perioperative complications and recurrent disc herniation rates were measured for the cohort. The presence or absence of postoperative cervical facet syndrome was documented for comparative analysis with respect to outcome.
Due to the small group sample sizes and lack of data normality, nonparametric statistical methods were used. Specifically, the difference in group medians was estimated using Hodges–Lehmann methodology, while the distribution free confidence intervals (CIs) are based on Moses. The corresponding P values are based on the Mann–Whitney Wilcoxon test. Significant findings were defined by a P < 0.05.
All surgeries were performed by a single neurosurgeon with the patient under general endotracheal anesthesia. Patients were ASA class 1 or 2 and received appropriate preoperative medical clearance. The cervical Deuk Laser Disc Repair® technique has been described in a prior publication.[
Mean operative time for the cohort was 57 minutes. Average operative blood loss was less than 5 ml. Average recovery time until discharge home was 52 minutes. There were no overnight stays.
Resolution of preoperative symptoms
All patients (n = 66) had significant improvement in their preoperative complaints including neck pain, headache, arm pain, and radicular symptoms (numbness, weakness, and paresthesias) [
Visual analog scale
There were no perioperative complications in any of the patients that underwent Deuk Laser Disc Repair®. Specifically, the incidence of vascular injury, new neurological deficit or symptom, hoarseness, dysphagia, discitis, infection, hematoma, dural injury, nerve root or spinal cord injury, death, cardiovascular, or pulmonary complication was zero. There were neither hospital admissions nor emergency room visits during the 30 day postoperative period.
Recurrent disc herniation rate
Recurrent disc herniation occurred in one patient (1.5%). The patient initially underwent Deuk Laser Disc Repair® at the C5-6 and C6-7 levels with excellent relief of symptoms. He reherniated both the C5-6 and C6-7 discs 3 weeks after his initial surgery and his preoperative symptoms recurred. A second C5-6, C6-7 Deuk Laser Disc Repair® was performed 2 months after his original surgery with findings of recurrent herniations in the same locations as his original injury and the patient ultimately achieved 95% resolution of his preoperative symptoms.
Average postoperative follow-up for the entire group was just over 3 months. A comparative analysis of outcomes was performed between the subgroup of patients with greater than 90 days follow-up (mean 320 days, n = 14) versus those patients with less than 90 days follow-up (n = 52). No significant intergroup difference was observed with respect to resolution of preoperative symptoms (P = 0.111) [
Cervical facet syndrome
Twelve patients in the cohort (12/66) were diagnosed with postoperative cervical facet syndrome. These patients were more likely to have residual symptoms related to the cervical spine after surgery. The mean resolution of preoperative symptoms in patients without postoperative cervical facet syndrome was 96.4%. In contrast, patients with postoperative cervical facet syndrome experienced only 86.8% resolution of their preoperative symptoms and the difference between the two groups was significant (P < 0.001) [
ACDF is currently the most common surgical treatment for medically refractory symptomatic disc herniations involving one or two cervical segments.[
Deuk Laser Disc Repair® was developed as a “disc preserving” surgical procedure for removing symptomatic herniated disc fragments without creating segmental kyphosis or instability. This transdiscal endoscopic technique allows preservation of the intervertebral disc and natural, unrestricted segmental motion. Herniated disc fragments are removed under direct endoscopic visualization of the posterior disc anatomy including the annular tear, posterior ligament, foramen, spinal cord, and nerve root. This is accomplished without removing the intervertebral disc by working through a 4 mm transdiscal cannula. Because the intervertebral disc is preserved with Deuk Laser Disc Repair® no interbody device, instrumentation, or fusion is necessary. The average volume of herniated disc material removed with Deuk Laser Disc Repair® was only 0.09 cm3 or an estimated 5% of a normal disc volume.[
Patients undergoing cervical Deuk Laser Disc Repair® had average operative and recovery times that were 57 and 52 minutes, respectively (n = 66). Operative times for ACDF have been reported in the literature to be between 40 and 240 minutes and recovery times between 20 hours and 4 days according to a recent meta-analysis.[
The patients in this study underwent cervical Deuk Laser Disc Repair® to treat preoperative symptoms determined to be caused by one or two adjacent spinal discs. Two spinal discs were included in the treatment plan when preoperative imaging demonstrated adjacent disc pathology that correlated clinically (exam, discography, and EMG/NCS) to the patient's axial or lateralized symptoms.[
Surgery was offered to eight patients with only axial pain that had failed preoperative treatments including therapy, facet injections, and epidural steroid injections. All eight of these patients had significant axial neck pain that colocalized on physical examination and/or evocative discography[
In this study, most patients had one or two postoperative follow up visits and were discharged from care because they were doing so well. The average follow up for the entire cohort was 3 months. The authors wanted to know if the clinical effect of surgery was lost over time. An analysis of the durability of the clinical effect of Deuk Laser Disc Repair® on preoperative symptoms was performed by stratifying the entire cohort into two subgroups: Short (less than 90 days) or long-term follow up. The short-term follow up subgroup achieved 95.3% resolution of preoperative symptoms. The long-term follow up subgroup achieved a similar effect of 92.5% resolution of preoperative symptoms with a mean follow up period of 320 days. The difference in outcomes between the two subgroups was not significant (P = 0.111). Other studies have reported similar results with respect to the durability of the surgical effect for endoscopic cervical discectomy.[
In conclusion, this study has demonstrated that Deuk Laser Disc Repair® is a safe and effective treatment option for one or two adjacent level(s) of symptomatic cervical disc disease. There have been no complications to date and the surgery may be performed safely in the outpatient setting. In this study, the patients reported 94.6% resolution of their preoperative symptoms related to cervical disc disease including both contained and noncontained disc bulges and herniations, spondylosis, degenerative disc disease, stenosis, and radiculopathy. All of the patients in this study were successfully treated without fusion or spinal implants.
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