Department of Spine Surgery, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; School of Life Sciences, Center for Medical Genetics , Central South University, Changsha, Hunan, China.
Department of Spine, The Second Xiangya Hospital of Central South University, Changsha, Hunan China.
Pain Physician. 2019 Jan;22(1):41-52.
Recently posterior cervical foraminotomy (PCF) performed using a minimally-invasive surgery (MIS) approach for cervical radiculopathy due to lateral disc herniation or osseous foraminal stenosis has gained popularity. As 2 dominating MIS techniques, whether FE-PCF or MI-PCF provides superior clinical outcomes remains controversial.
To compare clinical success rate, overall incidence of complications and reoperation rate between full-endoscopic posterior cervical foraminotomy (FE-PCF) and microendoscopic posterior cervical foraminotomy (MI-PCF) for cervical radiculopathy.
A systematic review and meta-analysis.
A literature search of Pubmed, Embase and Web of Science was conducted to identify comparative or single-arm studies concerning FE-PCF or MI-PCF. The pooled results were performed by calculating the effect size based on the logit event rate and reported with 95% confidence intervals (CI).
A total of 26 articles with 2003 patients (FE-PCF, 377; MI-PCF, 1626) were included. The pooled clinical success rate was 93.6% (CI: 90.0%-95.9%) for the FE group and 89.9% (CI: 86.6%-92.5%) for the MI group, which was not statistically significant (P = 0.908). Overall complication rates were 6.1% (CI: 3.2%-11.3%) and 3.5% (CI: 2.7%-4.6%) for the FE group and the MI group, respectively, with no significant difference (P = 0.128). Nevertheless, the specific constituents showed apparent disparity, with transient nerve root palsy in the FE group (12/16, 75.0%) and dural tear in the MI group (20/47, 42.6%) being the most commonly reported. the pooled reoperation rate, the FE group (4.8%, CI: 2.9%-7.8%) and the MI group (5.3%, CI: 3.4%-8.2%), also demonstrated no statistical difference (P = 0.741).
The indirect comparison eroded the reliability of results inevitably due to the paucity of randomized clinical trials or high quality prospective cohort studies.
Both FE-PCF and MI-PCF can offer an effective and relatively secure treatment for cervical radiculopathy. There was no significant difference in the pooled outcomes of clinical success rate, complication rate and reoperation rate between the 2 approaches.
Cervical radiculopathy, full-endoscopic, microendoscopic, posterior cervical foraminotomy, clinical outcome, complication, reoperation, meta-analysis.
由于外侧椎间盘突出或骨孔狭窄导致的颈椎病，经皮颈椎侧方入路内镜下颈椎间孔切开术（PCF）作为一种微创外科（MIS）技术已得到广泛应用。作为两种主要的 MIS 技术，经皮颈椎侧方入路内镜下颈椎间孔切开术（FE-PCF）和微内镜下颈椎侧方入路颈椎间孔切开术（MI-PCF）哪种方法具有更优的临床疗效仍存在争议。
比较全内镜下颈椎侧方入路颈椎间孔切开术（FE-PCF）和微内镜下颈椎侧方入路颈椎间孔切开术（MI-PCF）治疗神经根型颈椎病的临床成功率、总体并发症发生率和再次手术率。
系统评价和荟萃分析。
对 Pubmed、Embase 和 Web of Science 进行文献检索，以确定关于 FE-PCF 或 MI-PCF 的比较性或单臂研究。基于对数事件发生率计算效应量，并以 95%置信区间（CI）进行报告，从而得出汇总结果。
共纳入 26 项研究，涉及 2003 例患者（FE-PCF 组 377 例，MI-PCF 组 1626 例）。FE 组的临床成功率为 93.6%（CI：90.0%-95.9%），MI 组为 89.9%（CI：86.6%-92.5%），差异无统计学意义（P = 0.908）。FE 组和 MI 组的总体并发症发生率分别为 6.1%（CI：3.2%-11.3%）和 3.5%（CI：2.7%-4.6%），差异无统计学意义（P = 0.128）。然而，具体组成部分存在明显差异，FE 组中出现短暂神经根麻痹（12/16，75.0%），MI 组中出现硬脊膜撕裂（20/47，42.6%）的发生率较高。FE 组（4.8%，CI：2.9%-7.8%）和 MI 组（5.3%，CI：3.4%-8.2%）的再次手术率也无统计学差异（P = 0.741）。
由于随机临床试验或高质量前瞻性队列研究的缺乏，间接比较不可避免地削弱了结果的可靠性。
FE-PCF 和 MI-PCF 均可为神经根型颈椎病提供有效且相对安全的治疗方法。两种方法的临床成功率、并发症发生率和再次手术率的汇总结果无显著差异。
颈椎病；全内镜；微内镜；颈椎侧方入路减压术；临床疗效；并发症；再次手术；荟萃分析。
