Department of Spinal Surgery, 1st Affiliated Hospital, University of South China, Hengyang 412001, Hunan, People's Republic of China.
Eur Spine J. 2011 Jun;20(6):899-904. doi: 10.1007/s00586-010-1642-0. Epub 2010 Dec 11.
With minimally invasive technique becoming more popular, endoscopic operations such as arthroscopy or laparoscopy have become the standard of care in several other areas. In this study, we evaluated the 5-year follow-up outcomes of anterior cervical (Ahn et al. in Photomed Laser Surg 23:362-368, 2005) discectomy and interbody fusion (ACDF) performed via endoscopic approach. Sixty-seven patients who underwent anterior cervical discectomy and cage fusion performed using endoscopic technique were followed for at least 5 years. We reviewed the clinical and radiographic records of these patients. The postoperative radiographic measures accessed were the anterior intervertebral height (AIH) and the lordosis angle (LDA). Clinical outcomes were determined using the previously validated Japanese Orthopaedic Association (JOA) and the pain visual analog scale (VAS). Patients included had a minimal follow-up period of 5 years and based on the outcomes criteria (JOA, VAS), 86.6% of patients reported excellent or good results. The AIH increased on average 18.7% of the original height (p < 0.01), and the LDA were more physiologic at final follow-up. Of the 67 cases, there was no segmental instability, and the bone fusion rate was 100%. One patient required revision open ACDF due to adjacent segment disc herniation 6 years postoperatively. There were no intraoperative complications, dysphasia or esophageal injury in this study group. It indicated endoscopic technique for ACDF can obtain satisfactory results in patients with cervical disc herniation, cervical myelopathy, or radiculopathy. Compared with a traditional approach, this technique may be associated with less morbidity while improving cosmesis and postoperative recovery. Prospective randomized control trials are needed to directly compare these two procedures.
随着微创技术的日益普及，关节镜或腹腔镜等内镜手术已成为其他几个领域的标准治疗方法。在本研究中，我们评估了经内镜前路颈椎（Ahn 等人，Photomed Laser Surg 23:362-368, 2005）椎间盘切除术和椎间融合术（ACDF）的 5 年随访结果。67 例接受经内镜前路颈椎间盘切除术和椎间融合术的患者至少随访 5 年。我们回顾了这些患者的临床和影像学记录。术后影像学评估指标包括：前路椎间高度（AIH）和前凸角（LDA）。临床结果采用先前验证的日本矫形协会（JOA）和疼痛视觉模拟量表（VAS）进行评估。患者的随访时间至少为 5 年，根据结果标准（JOA、VAS），86.6%的患者报告结果为优或良。AIH 平均增加了原始高度的 18.7%（p<0.01），最终随访时 LDA 更符合生理。67 例患者中无一例发生节段性不稳定，骨融合率为 100%。1 例患者术后 6 年因相邻节段椎间盘突出症需要行翻修开放式 ACDF。本研究组无术中并发症、吞咽困难或食管损伤。这表明，对于颈椎间盘突出症、颈椎病或神经根病患者，内镜技术可获得满意的结果。与传统方法相比，该技术可能具有较低的发病率，同时改善美容效果和术后恢复。需要前瞻性随机对照试验来直接比较这两种手术方法。
