Youn Myung Soo, Shon Myeong Hwan, Seong Yoon Jae, Shin Jong Ki, Goh Tae Sik, Lee Jung Sub
Department of Orthopaedic Surgery, Myungeun Hospital, Busan, Republic of Korea.
Department of Orthopaedic Surgery, Medical Research Institute, Pusan National University School of Medicine, 1-10 Ami-Dong, Seo-Gu, Busan, 602-739, Republic of Korea.
Eur Spine J. 2017 Sep;26(9):2450-2458. doi: 10.1007/s00586-017-5017-7. Epub 2017 Mar 23.
The efficacy and safety of endoscopic posterior cervical foraminotomy (EPCF) have been demonstrated for single-level cervical radiculopathy, but no report in the medical literature has described the clinical results of two-level EPCF. The aim of this study was to assess the clinical and radiological outcomes of two-level EPCF performed in patients with cervical radiculopathy.
Twenty-two consecutive patients (9 females and 13 males) that underwent two-level EPCF with cervical radiculopathy from January 2012 to January 2014 were included in this study. Clinical outcomes were assessed before surgery and at 1, 3, 6, 12, and 24 months postoperatively using visual analogue scale for neck and arm, neck pain and disability scale (NPDS), and neck disability index (NDI) scores. Radiological outcomes were assessed by measuring segmental lordosis (SL), C2-7 lordosis, and disc height index (DHI) before surgery and at 12 and 24 months postoperatively.
Mean VAS, NPDS, and NDI scores were significant improved at 1 month postoperatively versus preoperative values and these improvements were maintained at 2 years after surgery. SL and C2-7 lordosis were significantly increased after surgery, and no instability in dynamic view was observed during the 2-year follow-up period. Percentage DHIs of operated discs were also maintained without significant change at 2 years after surgery. One patient suffered from transient motor palsy due to root retraction.
Two-level EPCF can be safely preformed and should be considered an alternative to two-level anterior cervical discectomy and fusion or open posterior cervical foraminotomy in selected patients.
内镜下颈椎后路椎间孔切开术（EPCF）治疗单节段颈椎病的疗效和安全性已得到证实，但医学文献中尚无关于双节段EPCF临床结果的报道。本研究的目的是评估双节段EPCF治疗颈椎病患者的临床和影像学结果。
本研究纳入了2012年1月至2014年1月期间连续接受双节段EPCF治疗颈椎病的22例患者（9例女性，13例男性）。在手术前以及术后1、3、6、12和24个月，使用颈部和手臂视觉模拟量表、颈部疼痛和功能障碍量表（NPDS）以及颈部功能障碍指数（NDI）评分评估临床结果。通过测量术前以及术后12和24个月的节段性前凸（SL）、C2-7前凸和椎间盘高度指数（DHI）来评估影像学结果。
与术前相比，术后1个月时平均VAS、NPDS和NDI评分显著改善，且这些改善在术后2年得以维持。术后SL和C2-7前凸显著增加，在2年随访期内未观察到动态视野下的不稳定情况。手术节段椎间盘的DHI百分比在术后2年也保持稳定，无显著变化。1例患者因神经根牵拉出现短暂性运动麻痹。
双节段EPCF可以安全实施，对于部分患者应被视为双节段颈椎前路椎间盘切除融合术或开放性颈椎后路椎间孔切开术的替代方案。
