Modified posterior full-endoscopic cervical discectomy for highly migrated cervical disc herniations

Background: Posterior full-endoscopic cervical discectomy (pFECD) is a minimally invasive technique for removing highly migrated cervical disc herniations (CDHs). However, the optimal working corridor and extent of bone resection must be individually tailored according to the direction and degree of disc migration in each patient. Methods: Two cases of highly migrated CDH were treated using pFECD with tailored bone removal. Case 1 (previously published) involved caudal migration of a C5/6 disc, which required partial pediculotomy. Case 2 involved cephalad migration of a C6/7 CDH, which was treated with partial upper pediculectomy. Results: In both cases, the migrated disc fragments – both cephalad and caudal – were completely removed without any neurological sequelae. Conclusion: Partial cephalad and caudal pediculotomy represents a safe and effective technical modification of the pFECD approach for significantly migrated CDHs.