Department of Spine surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
Department of orthopaedics, Yantai Affiliated Hospital of Binzhou Medical College, Yantai, 264100, Shandong Province, China.
BMC Musculoskelet Disord. 2019 Nov 18;20(1):548. doi: 10.1186/s12891-019-2920-6.
We investigated the clinical value of posterior percutaneous endoscopic decompression (PED) for single-segment cervical spondylotic myelopathy (CSM) and cervical spondylotic radiculopathy (CSR).
Clinical data from February 2016 to March 2018 were collected for 32 patients with single-segment CSM or CSR who underwent posterior cervical percutaneous large channel endoscopic decompression and completed a regular follow-up exam at 12 months after surgery. Patient data included: age (range 30-81 years and mean of 49.5 years) and surgical information (operation time, bleeding volume, hospital stay, complications, etc.). The Japan Orthopedic Association (JOA) score and pain visual analog scale (VAS) were used to evaluate the surgical outcome for each patient. Cervical spine radiographs were used to evaluate cervical curvature (Cervical spondylotic angle (CSA), C2-7 Cobb angle) and CT and MRI were used to assess the extent of laminectomy and nerve root decompression. The JOA score, VAS score, cervical curvature were analyzed statistically, and the clinical outcome was evaluated using modified Macnab criteria at the last patient follow-up exam.
The JOA and VAS scores were compared before and after surgery (1 day Pre-op; 3 days, 3 months and 12 months Post-op). The differences were statistically significant (P < 0.05). There were significant differences in cervical curvature (C2-7 Cobb angle) between the time points (1 day Pre-op; 3 days, 3 months and 12 months Post-op), but the differences were no statistically significant in CSA angle (P < 0.05) The operation time range was 45-110 min (mean 68.6 ± 23.8 min); the intraoperative blood loss range was 20-85 ml (mean28 ± 14.8 ml), and the hospital stay was 3-8 days (mean4.5 days). At the last follow-up, the clinical efficacy was evaluated using modified Macnab criteria. The results were excellent in 18 cases, good in 11 cases, and fair in 3 cases. The combined excellent and good rate was 93.75%. Postoperative CT and MRI showed that the compression of the spinal cord or nerve roots was completely relieved.
Endoscopic decompression of posterior cervical vertebral disorders is a safe, effective, and minimally invasive surgical procedure with rapid recovery times. This procedure warrants additional research and clinical application.
我们研究了后路经皮内镜减压术（PED）治疗单节段颈椎病（CSM）和神经根型颈椎病（CSR）的临床价值。
收集 2016 年 2 月至 2018 年 3 月间 32 例单节段 CSM 或 CSR 患者的临床资料，这些患者均行后路颈椎经皮大通道内镜减压术，术后 12 个月进行常规随访检查。患者资料包括：年龄（30-81 岁，平均 49.5 岁）和手术信息（手术时间、出血量、住院时间、并发症等）。采用日本骨科协会（JOA）评分和疼痛视觉模拟评分（VAS）评估每位患者的手术效果。颈椎侧位片评估颈椎曲度（颈椎病变角（CSA）、C2-7 Cobb 角），CT 和 MRI 评估椎板切除和神经根减压程度。对 JOA 评分、VAS 评分、颈椎曲度进行统计学分析，并采用改良 Macnab 标准对末次随访时的临床疗效进行评估。
比较了手术前后的 JOA 评分和 VAS 评分（术前 1 天，术后 3 天、3 个月和 12 个月）。差异具有统计学意义（P<0.05）。颈椎曲度（C2-7 Cobb 角）在各时间点之间存在显著差异（术前 1 天；术后 3 天、3 个月和 12 个月），但 CSA 角无统计学差异（P<0.05）。手术时间为 45-110 分钟（平均 68.6±23.8 分钟）；术中出血量为 20-85ml（平均 28±14.8ml），住院时间为 3-8 天（平均 4.5 天）。末次随访时，采用改良 Macnab 标准评价临床疗效。结果为优 18 例，良 11 例，可 3 例。优良率为 93.75%。术后 CT 和 MRI 显示脊髓或神经根受压完全缓解。
后路颈椎病变内镜减压术是一种安全、有效、微创的手术方法，具有恢复快的优点。该手术值得进一步研究和临床应用。
