Biportal Endoscopic Surgery With Trans-Pedicle Approach Treat Central Cervical Disc Herniation: A Keyhole Technique With Assisting Portals.

Abstract

Case series. Anterior cervical discectomy and fusion (ACDF) is the standard treatment for central cervical disc herniation but may cause complications like loss of motion, dysphagia, and adjacent segment degeneration. This study evaluates a novel Biportal Endoscopic Spinal Surgery with trans-pedicle approach (BESS-TPA) as a minimally invasive alternative, preserving cervical mobility by avoiding instrumentation. A retrospective analysis of 24 patients with central cervical disc herniation who underwent BESS-TPA at a single center from July 2022 to June 2023 was performed. Clinical outcomes were assessed using the modified Japanese Orthopaedic Association (mJOA) scores, SF-36 pain and physical function domains, and modified MacNab criteria. Radiographic evaluation with X-rays, CT, and MRI examined structural changes and surgical outcomes. All patients experienced significant symptom relief. Postoperative MRI confirmed complete resection of the herniated disc using the posterior approach. BESS-TPA provides a safe, effective, and minimally invasive alternative to ACDF for selected central or paracentral cervical disc herniation. It facilitates access to the ventral dura sac, enabling safer central discectomy while maintaining cervical spine mobility.