Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
Department of Orthopaedic Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.
World Neurosurg. 2018 Jun;114:217-227. doi: 10.1016/j.wneu.2018.03.099. Epub 2018 Mar 28.
Minimally invasive surgery of posterior cervical foraminotomy (PCF) for symptomatic radiculopathy has gained popularity in the last decade. It remains to be determined whether the 2 dominant operation techniques, full-endoscopic (FE) or microendoscopic (MI), are associated with fewer complications.
An electronic retrieval from PubMed, Embase, and Web of Science was performed to identify comparative or single-arm studies concerning FE-PCF and MI-PCF. The pooled incidence of complications was calculated.
A total of 26 studies with 2028 patients (FE, 402; MI, 1626) were identified. The overall complication rate was 5.8% for FE-PCF and 3.5% for MI-PCF, with no significant difference (P = 0.115). The pooled complication rate for single-level radiculopathy showed no statistical difference (FE, 4.5%; MI, 3.5%; P = 0.471), either. However, constituent of complications showed apparent disparity, with transient root palsy in FE-PCF (15/19, 78.9%) and dural tear (20/47, 42.6%) in MI-PCF being the most commonly reported. As for the subgroup analysis, both incidence of dural tear (FE, 1.5%; MI, 1.8%; P = 0.672) and superficial wound infection (FE, 2.2%; MI, 1.0%; P = 0.109) showed no statistical difference. Nevertheless, transient root palsy occurred at a higher incidence in the FE group than in the MI group (FE, 4.5%; MI, 1.5%; P = 0.002).
Both FE-PCF and MI-PCF can offer relatively safe treatment for cervical radiculopathy. There is no significant difference in overall complication rate between the 2 techniques. Dural tear is the most commonly reported complication of MI-PCF, whereas transient root palsy deserves to be noticed for surgeons performing FE-PCF.
在后颈椎侧方入路微创减压术（PCF）治疗神经根型颈椎病方面，微创技术在过去十年中得到了广泛应用。目前仍需确定两种主流手术技术，全内镜（FE）或微内镜（MI），哪种技术与更少的并发症相关。
对 PubMed、Embase 和 Web of Science 进行电子检索，以确定涉及 FE-PCF 和 MI-PCF 的比较或单臂研究。计算并发症的总发生率。
共纳入 26 项研究，共 2028 例患者（FE 组 402 例，MI 组 1626 例）。FE-PCF 的总体并发症发生率为 5.8%，MI-PCF 的并发症发生率为 3.5%，差异无统计学意义（P=0.115）。对于单节段神经根病变，FE-PCF 的并发症发生率为 4.5%，MI-PCF 的并发症发生率为 3.5%，差异也无统计学意义（P=0.471）。然而，并发症的构成存在明显差异，FE-PCF 中短暂神经根麻痹（15/19，78.9%）和 MI-PCF 中硬脊膜撕裂（20/47，42.6%）较为常见。亚组分析显示，硬脊膜撕裂（FE 组 1.5%，MI 组 1.8%，P=0.672）和浅表伤口感染（FE 组 2.2%，MI 组 1.0%，P=0.109）的发生率差异均无统计学意义。然而，FE 组的短暂神经根麻痹发生率明显高于 MI 组（FE 组 4.5%，MI 组 1.5%，P=0.002）。
FE-PCF 和 MI-PCF 均可为颈椎病患者提供相对安全的治疗。两种技术的总体并发症发生率无显著差异。MI-PCF 最常见的并发症是硬脊膜撕裂，而 FE-PCF 术后应注意短暂神经根麻痹。
