Endoscopic partial corpectomy using anterior decompression for cervical myelopathy.

Symptomatic ventral cervical cord compressions have been treated by anterior discectomy with fusion, anterior corpectomy and fusion, discectomy with an artificial disc, and minimally invasive techniques. There are complications associated with the fusion procedure, especially when a long segment fusion is undertaken. Partial removal of the vertebral body without fusion could help in avoiding fusion and its associated complications. We are describing the detailed surgical technique, indications, limitations, and early results of endoscopic partially corpectomy. The detailed endoscopic technique of how to remove minimal portion of the anterior and middle part of the vertebra with the removal of compressing posterior portion is described. To the best of the author's knowledge, this procedure has not been described in the literature till date. This technique has the advantages of preservation of most of the vertebral body and disc. The stability of the spine is maintained without the patient having to undergo the additional procedure of spinal fusion. There is a shorter length of hospital stay. The technique can also be used in special conditions, such as when a migrated disc behind the vertebral body or any bony compression opposite the vertebral body is encountered. It avoids injury to the longus colli muscles and damage to most of the annulus fibrosis. It preserves motion segments at the operated and adjacent segments without any significant decrease in the disc and vertebral height. A relatively short follow-up and the experience in a relatively small number of patients till now, are the limitations to the widespread use of this technique. Although long-term follow-up of this procedure in a large number of patients is not currently available, endoscopic partial corpectomy seems to be an effective and an alternative method for dealing with anteriorly located cervical compression. Long-term follow-up in a large number of patients is required to assess for the safety and effectiveness of the procedure.

Endoscopic surgery of spontaneous basal ganglionic hemorrhage.

INTRODUCTION: Although there are controversies about the optimal management of spontaneous intracerebral hemorrhage (ICH), benefits of endoscopic procedures in ICH have been reported. This study is aimed to evaluate the result of 270 patients undergoing endoscopic treatment of ICH. METHODS: This was a retrospective study from July 2008 to June 2017. All procedures were done with the endoscopic technique using a tubular retractor. Patients with the hematoma volume between 30 to 80 ml, with the Glasgow Coma Scale (GCS) between 5 to 14, and evidence of severe mass effect, were included in the study. RESULTS: The average stay in the intensive care unit was 6 days (range 1-17 days). The median pre-operative midline shift of 8.3 mm was reduced to 2.7 mm after surgery. The average hematoma removal ratio, the duration of surgery, and the blood loss was 90%, 90 min, and 60 ml, respectively. There was improvement in the average pre-operative GCS from 9.4 to 11.3 at seventh post-operative day. The post-operative mortality rate was 10.7%. A good outcome was observed in 71% patients at 6 months after surgery. Larger the volume of hematoma, more the operative time, more the pre-operative midline shift, and poorer the GCS, significantly higher was the association with mortality. The patients with a better pre-operative GCS were associated with a better Glasgow Outcome Score. The follow-up period ranged from 7 to 115 months. CONCLUSION: Endoscopic surgery with the help of a tubular retractor was effective and safe. It allowed for a good visualization of the hematoma and the surrounding brain, and helped in proper hemostasis. The hematoma may also be removed with the help of the microscope and the tubular retractor, in case any difficulty during the endoscopic technique is encountered.

Early Syringomyelia in Tubercular Meningitis.

Tubercular meningitis (TBM) can have various complications. Sometimes syringomyelia can also occur as a late complication of tubercular meningitis. Although syrinx formation in early stage of TBM is very rare. There are only four published case reports of syringomyelia in acute stage of TBM. Here we report a patient with tubercular meningitis who developed syringomyelia in early course of illness.

Concurrent Intramedullary and Intracranial Tuberculomass.

Tuberculosis of the central nervous system (CNS) is well known. CNS involvement can occur in the form of tubercular meningitis (TBM), tuberculous vasculitis, tuberculoma and rarely brain abscess. Tubercular granulomas generally solitary and occur in the brain but they may be multiple and involve other areas such as spinal cord, epidural space and subdural space also. Tuberculoma in the spinal cord is rare. Co-occurrence of intracerebral and intramedullary spinal tuberculoma is extremely rare in children with only few cases reported till date. We are reporting one such case in children and review of literature.

Endoscopic technique for single-stage anterior decompression and anterior fusion by transcervical approach in atlantoaxial dislocation.

Although posterior approaches are being used frequently in most atlantoaxial dislocations (AAD), anterior decompression is also required in some patients in whom the C1-2 dislocation is not properly reduced by the posterior approach. Transnasal and transoral approaches need an additional posterior approach to perform atlantoaxial fusion. They also have an added risk of infection. The endoscopic transcervical approach can be used for single-stage cervical decompression and stabilization that includes an odontoidectomy and anterior fusion. It can be used both in reducible and irreducible AAD. Patients with a high basilar invasion, traumatic or other lesions involving the C1 or C2 facet joint, reducible AAD with Chiari malformation, and patients with a large mandible or a mandible angle lying below the C3 level even after the maximum neck extension, should not be subjected to this procedure. Preoperative X-ray, computed tomography (CT) scan with angiogram, and magnetic resonance imaging of the craniovertebral region should be done to assess the dislocation. The early results of an endoscopic transcervical approach were found to be safe and effective for decompression and fusion in our experience. There was no permanent complication. The procedure avoids a two-stage surgery; thus, odontoidectomy, if needed, can be performed in addition to the C1-2 fusion in a single stage.

Spontaneous Resolution of Chronic Subdural Haematoma in a Patient Receiving Anticoagulant Therapy.

Significant chronic subdural hematoma (CSDH) is usually a surgical emergency. Spontaneous resolution of CSDH has rarely been reported in the literature. We are reporting a case of spontaneous resolution of CSDH in a patient receiving anticoagulant therapy who had undergone mitral valve replacement surgery.

Endoscopic anterior decompression in cervical disc disease.

BACKGROUND: Although microscopic anterior cervical discectomy with or without fusion are common surgical procedures for treatment of cervical herniated discs, loss of disc height, pseudarthrosis, and adjacent disc degeneration are some of the problems associated with it. This study is aimed to evaluate results of endoscopic microforaminotomy in cervical disc diseases. MATERIALS AND METHODS: A prospective study of 50 patients of mono segmental soft or hard disc causing myeloradiculopathy was undertaken. A visual analogue scale (VAS) for neck and arm pain and functional outcomes using the Nurick grading system were assessed. There were 28, 12, 8, and 2 patients at C5-6, C6-7, C4-5, and C3-4 levels disc diseases, respectively. Patients with two or more level disc, instabilities, disc extending more than half vertebral body height, and previous operation at the same segment were excluded. RESULTS: Age ranged from 21 to 67 years. Average postoperative reduction in disc height, operating time, and blood loss was 1.1 mm, 110 minutes, and 30 ml, respectively. Average pre-operative VAS score for arm pain and Nurick grading was 7.6 and 2.7, which improved to 1.9 and 0.82, respectively. All patients improved; 1, 2, 3 grade improvement was seen in 10, 27, and 10 patients, respectively. There was no significant complication or any mortality. CONCLUSION: Although longer follow up of large number of patients is required, endoscopic microforaminotomy is a safe and an effective alternative to microscopic anterior discectomy with or without fusion.

Endoscopic decompression of cervical spondylotic myelopathy using posterior approach.

BACKGROUND: Cervical spondylotic myelopathy, radiculopathy and myeloradiculopathy can be managed by laminoforaminotomy, or bilateral decompression using posterior approach in single or multilevel compression. Posterior endoscopic techniques allow preservation of motion segment and neural decompression without fusion. MATERIALS AND METHODS: A prospective study of 50 patients of cervical compressive myelopathy with primarily posterior lesion or multilevel anterior compression with acceptable preoperative lordosis was undertaken. Any instability, significant anterior compression, and cervical myelopathy secondary to tumor, trauma, severe ossification of posterior longitudinal ligament, rheumatoid arthritis, pyogenic spondylitis, and destructive spondylo-arthropathy were excluded from the study. There were 5, 23, 12, 10 patients with 2, 3, 4, 5 vertebral body level pathologies, respectively. RESULTS: There were 2, 4, 7, 32, and 5 patients in preoperative Nurick grade 0, 1, 2, 3, and 4, respectively with an average of 2.6 grades. All the patients improved in post-operative grading with 10, 34, and 6 patients in 0, 1, and 2 grades (average 0.92), respectively. Better outcome was observed in patients with good preoperative grade and in short segment compression on cord. There was no change in cervical Cobb angle after surgery. Follow-up ranged from 6 to 24 months (averages 19 months). There was small dural tear, minor bleeding from muscles or epidural vessels and temporary C 5 root injury in 1, 3, and 2 patients, respectively. CONCLUSION: Endoscopic decompression of cervical spondylotic myelopathy is a safe and an effective alternative treatment option in selected patients when pathologic changes are primarily posterior or multi level anterior lesions with acceptable preoperative lordosis.

Endoscopic Management of Chronic Subdural Hematoma Using a Novel Brain Retractor.

BACKGROUND: Endoscopic procedures are useful in chronic subdural hematoma especially when there are septations, solid/organized hematoma, and the presence of bridging or neovessels in the cavity. Visualizing the distal hematoma cavity by a rigid scope is challenging in large and curved ones due to the hindrance by the brain surface. Combining rigid endoscopy and brain retractor can overcome this limitation. METHODS: A retrospective study of 248 patients managed by endoscopic technique was performed and the relevant literature was reviewed. RESULTS: The brain retractor was used in all patients. Average operative time, subgaleal drainage duration, and hospital stay were 56 minutes, 3.1 days, and 4.6 days, respectively. The average preoperative Glasgow coma scale (GCS) score was 12, which improved to 14 and 15 in 223 and 23 patients, respectively at discharge. There were solid clots, septations, bridging vessels, curved hematoma cavities, rapid expansion of the brain after partial hematoma removal, and recurrences in 59, 52, 15, 49, 19, and 2 patients, respectively. There were 2 deaths, without any procedure-related mortality. CONCLUSIONS: Endoscope was very effective and safe in the management of chronic subdural hematoma, especially in about 51% patients with solid clots, septations, and bridging vessels which could have been difficult to treat by conventional burr hole. It can avoid craniotomy in such patients. Good visualization and complete hematoma removal were possible with the help of an endoscope and brain retractor in about 27% of patients which could have been difficult with a rigid endoscope alone.

A Model with Feedback Mechanism for Learning Hand-Eye Coordination: A Pilot Study.

BACKGROUND: Practicing neuroendoscopic skills like hand-eye coordination is mandatory before embarking on actual surgeries. Synthetic models are able alternatives for cadavers and animals. Presently available models in the literature are either very costly or lack a feedback mechanism, which makes training difficult. OBJECTIVE: We aimed to make a basic low-cost neuroendoscopic hand-eye coordination model with a feedback mechanism. METHODS AND MATERIALS: An electronic circuit in series was designed inside a clay utensil to test inadvertent contact of the working instrument with implanted steel pins, which on completion lighted a light-emitting diode (LED) and raised an alarm. Two exercises-moving-a-rubber exercise and passing copper rings of multiple sizes were made and tested by 15 neurosurgeons. RESULTS: The moving-a-rubber exercise was completed by 6/15 (40%) neurosurgeons in the first attempt, 6/15 (40%) in the second, and 3/15 (20%) in the third attempt. For the 1.5 cm copper ring passing exercise, 12/15 (80%) successfully performed in the first attempt; for 1 cm copper ring, 6/15 (40%) performed in the first; and for the 0.5 cm copper ring, 1/15 (6.6%) performed in the first attempt. The time to finish all the exercises significantly decreased in the third successful attempt compared to the first. CONCLUSION: The model gave excellent feedback to the trainee and examiner for basic neuroendoscopic hand-eye coordination skills.

Endoscopic Posterior Approach for Cervical Myelopathy and Radiculopathy Using Tubular Retractor: Our Experience, Surgical Technique, and Literature Review.

BACKGROUND: Endoscopic posterior approach can effectively decompress cervical root and cord secondary to posterior compression. We present our experience in 229 patients using tubular retractor, and the relevant literature is reviewed. METHODS: Retrospective analysis of multilevel myelopathy and or radiculopathy was performed. Indications for posterior approach was primary posterior compressions at cord and or root. Combined compression from posterior side and mild to moderate anterior pressure with acceptable lordosis were also decompressed. Bilateral cord decompression and foraminotomy for radiculopathy was performed using tubular retractor. RESULT: Myelopathy and radiculopathy were present in 220 and 9 patients, respectively. A total of 53 foraminotomy procedures were performed in 36 patients. All patients showed improvement, with the mean preoperative Nurick grade decreasing from 2.72 ± 0.799 to 0.78 ± 0.911 after surgery. There was significant improvement in postoperative Nurick grades compared with preoperative grades (Z-value = 13.306, P < 0.0001). Operative results were better in patients with good preoperative Nurick grades (grades 1 and 2) compared with those with poorer grades (grades 3 and 4). Minor bleeding, small dural tear, and root injury were observed in 42, 4, and 8 patients, respectively. CONCLUSIONS: Endoscopic approach was effective and safe for root and cord decompression. This study was limited by its single-center, retrospective design, exclusion of some eligible patients, a short postoperative Nurick grade assessment period of 6 months, and absence of a comprehensive long-term postoperative biomechanical assessment. To validate these results, a prospective multicenter study addressing these limitations is needed.

The Rocker Technique for Atlantoaxial Dislocation With or Without Basilar Invagination: A Prospective Observational Study.

BACKGROUND AND OBJECTIVES: Atlantoaxial dislocation (AAD) poses a complex surgical challenge. Surgical approaches vary for reducible and irreducible cases. Challenges persist in reducing the atlantodental interval, especially in cases with oblique or vertical C1-C2 joints. The Rocker instrument (MJ Surgical), a less-explored technique, seeks to simplify instrumentation, reduce complexity, and enhance translation and retroflection reduction of AAD. METHODS: This prospective observational study was conducted from January 2022 to July 2023 at a tertiary neurosurgical center. Inclusion criteria covered all age groups with AAD, with or without basilar invagination. Exclusions included medically unstable patients and severe osteoporotic spine conditions. Preoperative assessments included dynamic X-rays, magnetic resonance imaging, and computed tomography scans. The Rocker technique was used, and patients were followed up for 6 to 12 months. RESULTS: Fifty-five patients (30 males, 25 females) underwent surgery. The mean age was 40.41 ± 15.01 years. Successful Rocker technique application was observed in 53 cases. Functional outcomes, assessed using Modified Ranawat grading, showed improvement postoperatively. Radiological outcomes revealed a significant reduction in the anterior atlantodental interval (7.21 ± 0.94 to 2.98 ± 0.78). Basilar invagination was reduced in all cases, whenever present. The technique exhibited versatility, applicability in various joint orientations, and cost-effectiveness. CONCLUSION: The Rocker technique is a safe and effective alternative for managing both reducible and irreducible AADs, with or without basilar invagination. It simplifies the reduction process, offering advantages over established techniques. Further trials, especially in rotational deformities, are warranted for validation.

A Novel Brain Retractor for Endoscopic Evacuation of Chronic Subdural Hematoma.

Background: Endoscopic chronic subdural hematoma (CSDH) evacuation is a safe and effective alternative to the conventional burr hole technique. Although a rigid endoscope has the advantage of good visualization, there are risks of brain damage due to limited space to accommodate the scope and frequent lens soiling. Objective: This technical note describes a novel brain retractor to overcome the limitations of rigid endoscopy. Methods: The novel brain retractor (by senior author) was made by dividing a silicon tube longitudinally into two halves, and tapered for easy introduction in the operative cavity. Sutures were placed at the outer end of the retractor to prevent migration and to assist in angulation. Results: The novel retractor along with endoscopic assistance was used in 362 CSDH procedures. Endoscopy combined with this retractor provided additional help in complete removal of hematoma in organized/solid clots, septa, bridging vessels, and rapid expansion of brain in 83, 23, 21, and 24 patients, respectively (n = 151, 44%). Although there were three deaths (due to poor preoperative status), and two recurrences, there were no retractor-induced complications. Conclusions: The novel brain retractor assists endoscope in proper visualization of complete hematoma cavity by gentle and dynamic brain retraction, helps in thorough irrigation of hematoma cavity, protects the brain, and prevents lens soiling. It allows easy insertion of the endoscope and instruments using bimanual technique even in patients with a small width of hematoma cavity.

Epilepsy-Related Injuries in Children: An Institution-Based Study.

Background: Epilepsy carries a lifetime risk of seizure-related accidents. The risk varies according to the socioeconomic profile of a place. Sufficient data is lacking for epilepsy-related accidents in the pediatric population. Objective: We aimed to identify the proportion of pediatric epileptic patients who met with accidents and their associated factors. Methods: A prospective study was done. Patients of less than 18 years with epilepsy of more than 1-year duration were included and were given a questionnaire modified for the pediatric population. The demography of accidents during seizures and drugs taken were recorded. Results: 135 epileptic children were included. 70.4% of patients suffered seizure-related accidents ranging from 1-10 accidents in their epilepsy duration. Falls (83.15%) were the most common, 25.26% of them required hospitalization. Accidents due to missing of drug dosage were observed in 23% patients. Conclusion: Seizure-related accidents are common in the pediatric population, and may lead to major accidents. Better epilepsy management with extra care for high-risk epilepsy patients may decrease their incidents.

Endoscope-controlled Access to Thalamic Tumors using Tubular Brain Retractor: An Alternative Approach to Microscopic Excision.

BACKGROUND: Surgery for thalamic lesions has been considered challenging due to their deep-seated location. Endoscopic excision of deep-seated brain tumors using tubular retractor has been shown to be safe and effective in prior studies; however, there are limited reports regarding its use for thalamic tumors. We present our experience of endoscope-controlled resection of thalamic tumors using a tubular retractor. MATERIAL AND METHODS: This was a prospective observational case series done at a tertiary center specialized for endoscopic neurosurgery during the period from 2010 to 2019. Surgeries were performed under the endoscopic control using a silicon tubular retractor. Lesions were approached transcortically or trans-sulcally. Data were collected for the extent of resection, amount of blood loss, operative time, need for conversion to microscopy, and complications. RESULTS: Twenty-one patients of thalamic masses of 14- to 60-year age underwent the surgeries. Pathologies ranged from grade I to IV gliomas. Gross total and near-total resection could be done in 42.85% of cases for each group. The average blood loss and operative time were164.04 ± 83.63 mL and 157.14 ± 28.70 minutes, respectively. Complications included a small brain contusion, two transient hemipareses, and one transient speech deficit. CONCLUSION: Endoscopic excision of thalamic tumors using a tubular retractor was found to be a safe and effective alternative to microscopic resection.

Endoscopic-Assisted C2 Transverse Process Mass Excision.

BACKGROUND AND INTRODUCTION: C2 transverse process exostoses are rare lesions. Due to critical structures surrounding them, their excision is challenging. There are sparse reports of anterior retropharyngeal approach (ARPA) for high-cervical transverse process mass and none for endoscopic ARPA approach. OBJECTIVE: A step-by-step technical report with its video is presented. SURGICAL TECHNIQUE: A 14-year-old girl presented with chronic right-sided neck pain. The computed tomography scan revealed a 6.5 cm3 mass in the right transverse process extending into the lateral mass of the C2 vertebra. The mass was anterior and in direct contact with the vertebral artery. She underwent a minimally invasive endoscopic ARPA. RESULTS: The mass could be excised along with its cartilaginous cap without any complications. The patient's symptoms resolved completely. The biopsy came out as osteochondroma. CONCLUSION: Endoscopic ARPA is a minimally invasive option for high-cervical tumors and was found safe and effective for C2 transverse process osteochondroma.

Comparison of Peripheral Neurectomy vs. Medical Treatment for Migraine: A Randomized Controlled Trial.

BACKGROUND: Migraine is a common form of primary neurologic headache. Many patients are chronic migraineurs and suffer from a significant disability and adverse effects of drugs. There are various surgical options available to treat migraines, including peripheral neurectomies. OBJECTIVE: To study the surgical and functional outcomes of migraine surgeries using peripheral neurectomies and compare them with conservatively treated patients. MATERIALS AND METHODS: Migraine patients who had a unilateral onset pain were given local bupivacaine block at the suspected trigger site, and those who were relieved were given the option for surgery. In the operative group, the peripheral nerve of the trigger site was lysed under local anesthesia. The conservative group was continued with the standard treatment. Evaluations with a baseline and 6 months visual analog score (VAS), migraine headache index (MHI), migraine disability assessment test (MIDAS), and pain self-efficacy questionnaire (PSEQ) scores were done. RESULTS: A total of 26 patients got benefitted with the local bupivacaine block, out of which 13 underwent surgery. At baseline, the VAS, MHI, MIDAS, and PSEQ scores were similar in both the groups. The operative group had significant (P < 0.001) improvement in all these parameters 6 months after the surgery. All patients of the operative group got free from prophylactic migraine treatment; however, 11 out of 13 patients still needed occasional  use of analgesics. There was one complication of transient temporal numbness. CONCLUSION: Migraine surgery using peripheral neurectomies was more effective than chronic drug treatment in appropriately selected patients.

Endoscopic Third Ventriculostomy - A Review.

BACKGROUND: Endoscopic third ventriculostomy (ETV) has become a proven modality for treating obstructive and selected cases of communicating hydrocephalus. OBJECTIVE: This review aims to summarize the indications, preoperative workup, surgical technique, results, postoperative care, complications, advantages, and limitations of an ETV. MATERIALS AND METHODS: A thorough review of PubMed and Google Scholar was performed. This review is based on the relevant articles and authors' experience. RESULTS: ETV is indicated in obstructive hydrocephalus and selected cases of communicating hydrocephalus. Studying preoperative imaging is critical, and a detailed assessment of interthalamic adhesions, the thickness of floor, arteries or membranes below the third ventricle floor, and prepontine cistern width is essential. Blunt perforation in a thin floor, while bipolar cautery at low settings and water jet dissection are preferred in a thick floor. The appearance of stoma pulsations and intraoperative ventriculostomography reassure stoma and basal cistern patency. The intraoperative decision for shunt, external ventricular drainage, or Ommaya reservoir can be taken. Magnetic resonance ventriculography and cine phase-contrast magnetic resonance imaging can determine stoma patency. Good postoperative care with repeated cerebrospinal fluid drainage enhances outcomes in selected cases. Though the complications mostly occur in an early postoperative phase, delayed lethal ones may happen. Watching live surgeries, assisting expert surgeons, and practicing on cadavers and models can shorten the learning curve. CONCLUSION: ETV is an excellent technique for managing obstructive and selected cases of communicating hydrocephalus. Good case selection, methodical technique, and proper training under experts are vital.

Lumboperitoneal Shunts - Patient Selection, Technique, and Complication Avoidance: An Experience of 426 Cases.

BACKGROUND: Lumboperitoneal shunt is a known procedure for communicating hydrocephalus. Being an extracranial procedure, it can also be utilized in normal-sized ventricles. OBJECTIVE: To report our experience of lumboperitoneal shunt done with a minimal follow-up of 12 months with an emphasis on patient selection, technique, and complication avoidance. METHODS: This was a retrospective analysis of patients who underwent LP shunt during October 2014-October 2019 at the authors' institute. Inclusion criteria were patients with communicating hydrocephalus due to tubercular meningitis, normal pressure hydrocephalus, idiopathic intracranial hypertension, and postoperative refractory cerebrospinal fluid leaks. Data were collected for demographics, Glasgow coma scale and Glasgow outcome scale, vision, gait, memory, urinary incontinence, failed attempts, and complications. RESULTS: A total of 426 patients underwent the LP shunt procedure. The commonest indication was tubercular meningitis followed by idiopathic intracranial hypertension and normal pressure hydrocephalus. Age ranged from 16 to 72 years. There were 255 male and 171 female patients. The mean follow-up was 41 ± 8 months. Overall, 301 patients (70.6%) had neurological improvement. Shunt-related complications occurred in 112 (26.29%) patients, of which shunt block was the commonest. Other complications were infection in 17 (3.9%) patients and extrusion in four (0.9%) patients. Transient postural headache was seen in 46 (10.7%) patients, which gradually improved. CONCLUSION: Lumboperitoneal shunt was found to be a safe and effective treatment in appropriately selected communicating hydrocephalus patients. A meticulous technique reduces the complication rate.

Endoscopic Anterior Cervical Discectomy (Disc Preserving).

BACKGROUND AND INTRODUCTION: Endoscopic anterior cervical approach has several advantages compared to conventional anterior cervical discectomy and fusion (ACDF). OBJECTIVE: This video demonstrates a step-by-step procedure for endoscopic anterior cervical discectomy. PROCEDURE: The patient is placed supine with the neck extended. A standard anterior cervical approach using about 3 cm skin incision is made and under "Easy Go" (Karl Storz, Tuttlingen, Germany) endoscopic vision, the uncinate process and uncus are drilled. Only a small portion of the normal disc, posterior longitudinal ligament (PLL), and compressing disc is removed. The closure is done in a standard manner. RESULTS: In 240 patients, the average postoperative reduction in disc height, operating time, and blood loss were 1.1 ± 0.2 mm, 110 ± 17 min, and 30 ± 11 mL, respectively. The average postoperative VAS score and Nurick grading improved significantly. There were no permanent complications or any mortality. CONCLUSION: Endoscopic technique is an effective and safe alternative to ACDF after attaining the learning curve.