Yang Jun-Song, Chu Lei, Chen Liang, Chen Fu, Ke Zhen-Yong, Deng Zhong-Liang
From the Department of Orthopaedics, the Second Affiliated Hospital, Chongqing Medical University, Chongqing, China.
Spine (Phila Pa 1976). 2014 Oct 1;39(21):1743-50. doi: 10.1097/BRS.0000000000000508.
This is a retrospective comparative cohort study.
To compare the outcomes of patients with symptomatic cervical intervertebral disc herniation (CIVDH) treated with full-endoscopic cervical discectomy (FECD) using the anterior approach with those treated with the posterior approach.
The optimal FECD surgical approach for CIVDH remains controversial.
From March 2010 to July 2012, a total of 84 consecutive patients with symptomatic single-level CIVDH who underwent FECD using the anterior approach (42 patients) or the posterior approach (42 patients) were enrolled. Patients were assessed neurologically before surgery and followed up at regular outpatient visits. The clinical outcomes were evaluated using the visual analogue scale and the modified MacNab criteria. Radiographical follow-up included the static and dynamic cervical plain radiographs, computed tomographic scans, and magnetic resonance images.
In both groups, shorter mean operative time (63.5 min vs. 78.5 min), increased mean volume of disc removal (0.6 g vs. 0.3 g), larger mean decrease in the final postoperative mean intervertebral vertical height (1.0 mm vs. 0.5 mm), and longer mean hospital stay (4.9 d vs. 4.5 d) were observed in the anterior full-endoscopic cervical discectomy group. Postoperatively, the clinical outcomes of the 2 approaches were significantly improved, but the differences between the 2 approaches were not significant (P = 0.211 and P = 0.257, respectively). Four surgery-related complications were observed among all enrolled patients (complications in each group were 2; overall 4 of 84, 4.8%).
In our study, the clinical outcomes between the 2 approaches did not differ significantly. Nevertheless, posterior full-endoscopic cervical discectomy may be preferable when considering the volume of disc removal, length of hospital stay, and the postoperative radiographical changes. As an efficacious supplement to traditional open surgery, FECD is a reliable alternative treatment of CIVDH and its optimal approach remains open to discussion.
这是一项回顾性比较队列研究。
比较采用前路全内镜下颈椎间盘切除术（FECD）与后路手术治疗有症状的颈椎间盘突出症（CIVDH）患者的疗效。
CIVDH的最佳FECD手术入路仍存在争议。
2010年3月至2012年7月，连续纳入84例有症状的单节段CIVDH患者，其中42例行前路FECD手术，42例行后路手术。术前对患者进行神经功能评估，并定期门诊随访。采用视觉模拟评分法和改良MacNab标准评估临床疗效。影像学随访包括颈椎静态和动态X线平片、计算机断层扫描和磁共振成像。
在前路全内镜下颈椎间盘切除术组中，平均手术时间较短（63.5分钟对78.5分钟），平均椎间盘切除量增加（0.6克对0.3克），术后最终平均椎间垂直高度平均下降幅度较大（1.0毫米对0.5毫米），平均住院时间较长（4.9天对4.5天）。术后，两种手术方式的临床疗效均有显著改善，但两种手术方式之间的差异无统计学意义（P值分别为0.211和0.257）。所有纳入患者中观察到4例与手术相关的并发症（每组2例；84例中共有4例，4.8%）。
在我们的研究中，两种手术方式的临床疗效差异无统计学意义。然而，考虑到椎间盘切除量、住院时间和术后影像学变化，后路全内镜下颈椎间盘切除术可能更可取。作为传统开放手术的有效补充，FECD是CIVDH的可靠替代治疗方法，其最佳手术入路仍有待讨论。
3级。
