Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation? A comparative cohort study.

STUDY DESIGN

This is a retrospective comparative cohort study.

OBJECTIVE

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.

SUMMARY OF BACKGROUND DATA

The optimal FECD surgical approach for CIVDH remains controversial.

METHODS

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.

RESULTS

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%).

CONCLUSION

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.

LEVEL OF EVIDENCE