S008: OPTIMIZED USE OF OROGASTRIC AND ENDOTRACHEAL TUBES IN PERCUTANEOUS CERVICAL DISCECTOMY: A TECHNIQUE TO PREVENT ESOPHAGEAL AND TRACHEAL INJURY
Ashraf Sakr, MD1; Mahmoud Qandeel, MD2; Wael Elkholy, MD3
1Robert Wood Johnson Medical School; 2Henry Ford Wyandotte Hospital; 3Precision pain and spine institute
Background: Percutaneous cervical discectomy is a minimally invasive procedure for cervical disc herniation, but esophageal and tracheal injuries remain a concern. This study evaluates the effectiveness of a refined technique incorporating orogastric tube (OGT) and endotracheal tube (ETT) adjustments to mitigate these risks.
Methods: A retrospective analysis was conducted on 157 patients who underwent percutaneous cervical discectomy between 2023 and 2024. A standardized approach using ETT and nasogastric tube (NGT) placement was employed to delineate the trachea and esophagus. The ETT served as a radiopaque marker for the anterior tracheal border, while the OGT outlined the posterior esophageal border. Under fluoroscopic guidance, the needle trajectory was carefully navigated through the safe plane between the trachea and esophagus.
The procedures were performed at the following levels:
C3-C4 (1.3%)
C4-C5 (12.3%)
C5-C6 (39.8%)
C6-C7 (16.6%)
Two combined levels (12.3%)
The mean age was 47.0 ± 12.4 years, with 44.6% male and 55.4% female patients (M:F = 7:9). Patient demographics, surgical outcomes, and complication rates were analyzed.
Results: The technique ensured accurate localization and safe access to the cervical disc space in all cases. Despite potential risks, no esophageal or tracheal injuries were observed, resulting in a 0% complication rate. Additionally, no cases of dysphagia, hoarseness, or airway compromise were recorded.
By comparison, prior studies have reported esophageal injury rates ranging from 0.02% to 1.15% (Joaquim et al., 2014) (Fountas et al., 2007). Tracheal injuries are rare, though case reports have documented their occurrence (Wang et al., 2022).
Statistical analysis confirmed C5-C6 as the most commonly affected level (p < 2.17 × 10?²4), while gender distribution was not significantly different (p = 0.175).
Conclusion: The use of OGT and ETT as anatomical markers in percutaneous cervical discectomy significantly enhances procedural safety by eliminating esophageal and tracheal injuries. Compared to previously reported complication rates, this technique demonstrated a superior safety profile with a 0% injury rate. These findings support the continued use of this approach to reduce risks in anterior cervical spine procedures. Further studies with larger cohorts are recommended.