A variety of effective surgical options exist for the treatment of patients with degenerative disease of the cervical spine. Generally, surgeons preferentially use the anterior approach to the cervical spine and interspaces, which frequently ensued by whole discectomy and fusion. This modality is rather safe and provides the benefit of directly exposing the offending pathology along with the verification of the decompression of the compromised neural structures. However, as with the previous series, the potential complications after fusion surgery would be the graft or instrument failure, longer duration of operation or hospital stay, necessity to wear brace for several months, and possibility of yielding adjacent segment disease. Moreover, placing the grafts or instruments properly over the high cervical or cervicothoracic junction area would not be an easy procedure during the fusion surgery.

The previous reports on the outcome after anterior cervical discectomy without fusion varies among the institutes [1,2,5,6]. However, after careful selection of the patients with isolated cervical soft disc herniation or focal osteophyte formation without instability, subluxation, malalignment, or loss of normal cervical lordosis, the number of the patients that required a delayed fusion procedure could be reduced to less than 1.5% [4]. With these promising results from the literature, the authors have pursued direct removal of disc space pathology through transcorporeal route from the subjects that have met those selection criteria, leaving the majority of the anterior and central disc, anterior longitudinal ligament, and both upper and lower vertebral endplates intact. This selective removal procedure might exclude the fusion surgery -related complications while deterring the development of subsequent instability. Moreover, since it includes an ‘oblique’ drilling procedure, this might also give a more free access to the region such as high cervical or cervicothoracic junction.

The conventional surgical treatment modality for the isolated cervical disc pathology that most surgeons would choose would be anterior cervical discectomy and fusion. However, getting access to or placing a solid plate and screw along with bone graft down to T2 level even after full decompression would be quite demanding and therefore would require big longitudinal incision along the sternum. Moreover, the combined cervical pathology, as in the second case, would conventionally have required multilevel fusion surgery.

The choice of selective removal of herniated pathology through transcorporeal route would be proper for these patients, as the procedure might adequately decompress the spinal cord while relegating the necessity to perform a complicated surgical approach or multi-level fusion. However, as the authors have described earlier, the subjects with the evidence of cervical instability, subluxation, malalignment, or loss of normal cervical lordosis especially at the corresponding level should be refrained from undergoing this procedure [4].

The expected surgery-related complication after transcorporeal decompression procedures would be: (1) the cord injury especially during the final stage of vertical drilling, (2) the cerebrospinal fluid leakage during the removal of the compressive pathology, (3) a kyphotic progression of the cervical curvature, and (4) inadequate decompression or recurrence. The cases described above showed no evidence of the complication with complete resolution of their preoperative disabling symptoms.

The purpose of the transcorporeal selective decompression without fusion for the isolated cervical disc pathology would be that achieving adequate decompression through anterior approach while minimizing the effect on the motion segment of the cervical vertebrae [7]. The conventional anterior cervical discectomy followed by fusion is a safe, direct, and associated with higher success rate for the treatment of cervical discogenic diseases, but it is frequently ensued with potential complications such as loss of a motion segment, graft or instrument failure, or the development of adjacent segment disease. While the most surgeons would apprehend that the performance of cervical discectomy without fusion might yield the consequence of the development of postoperative instability or subsidence of disc space, mere disruption of less than 10 to 15% of vertebral area through transcorporeal route or partial removal of the posteriorly herniated disc during this selective, decompressive procedure might obviate these concerns [3,7]. Moreover, there are many proven previous literature supporting the evidence that minor loss in disc height and minor alterations in cervical sagittal curvature after anterior cervical discectomy without fusion do not affect the long-term outcomes [1-3,7]. Moreover, since it is an ‘oblique’ procedure, surgeons could use simple incision over the safe cervical region between superior and inferior thyroid artery, thereby avoiding the complicated incision or approaching steps to the high cervical or cervicothoracic junction area(FIg. 1-5), which would not be a readily accessible region during the fusion surgery.

Since it is a very selective procedure working on the very narrow surgical field, chances exist that surgeon might miss the remnant pathology. However, with the recent assistance of the Iso-3-dimensional intraoperative fluoroscopy, these possibilities of the residual pathology have been significantly decreased.