Abstract
BACKGROUND: Highly migrated cervical disc herniations are rare, and the optimal surgical approach remains uncertain. When located in the median or paramedian position, anterior cervical discectomy and fusion or anterior cervical corpectomy and fusion are preferentially selected, whereas posterior approaches are often considered for cases with radiculopathy. CASE DESCRIPTION: A 40-year-old woman presented with right C6 radicular symptoms without any specific triggering event. She initially experienced symptom relief through medication and an ultrasound-guided nerve block 4 years previously. The symptoms recurred 2 months before presentation and did not improve with conservative treatment. Magnetic resonance imaging revealed a paramedian herniation on the right side, migrating downward from the C5/6-disc level to the inferior border of the pedicle. Posterior endoscopic cervical discectomy (PECD) with partial pediculotomy was performed under general anesthesia with transcranial motor-evoked potential monitoring. The operative time was 56 min. The patient experienced immediate symptom relief, mobilized 3 h postoperatively, and was discharged the following day. CONCLUSION: PECD with partial pediculotomy is a minimally invasive and effective option for treating highly down-migrated cervical disc herniation, offering reduced tissue disruption, faster recovery, and excellent clinical outcomes.