经术中运动诱发电位监测的全内窥镜与微内窥镜颈椎侧方椎间孔切开术微创性的对比研究。

A Comparative Study on the Minimal Invasiveness of Full-Endoscopic and Microendoscopic Cervical Foraminotomy Using Intraoperative Motor Evoked Potential Monitoring.

机构信息

Department of Orthopaedic Surgery, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan.

Department of Orthopaedic Surgery, Oono Central Hospital, 3-20-3 Shimokaizuka, Ichikawa-shi, Chiba 272-0821, Japan.

出版信息

Medicina (Kaunas). 2020 Nov 11;56(11):605. doi: 10.3390/medicina56110605.

Abstract

Full-endoscopic cervical foraminotomy (FECF) and microendoscopic cervical foraminotomy (MECF) are effective surgeries for cervical radiculopathy and are considered minimally invasive in terms of damage to paraspinal soft tissue. However, no studies have quantitatively compared FECF and MECF in terms of neurological invasiveness. The aim of this study was to compare the neurological invasiveness of FECF and MECF using intraoperative motor evoked potential (MEP) monitoring. A chart review was conducted of 224 patients with cervical radiculopathy who underwent FECF or MECF between April 2014 and March 2020. Patients were 37 women and 187 men, with a mean age of 51 (range, 21-86) years. FECF was performed in 143 cases and MECF was performed in 81 cases. Average MEP amplitude significantly increased from 292 mV before to 677 mV after nerve root decompression in patients who underwent the FECF. The average improvement rate was 273%. In patients who underwent the MECF, average MEP amplitude significantly increased from 306 mV before to 432 mV after nerve root decompression. The average improvement rate was 130%. The improvement rate was significantly higher for FECF compared with MECF. MEP amplitude increased after nerve root decompression in both FECF and MECF, but the improvement rate was higher in FECF. These results suggest that FECF might be more minimally invasive than MECF in terms of neurological aspects.

摘要

全内镜下颈椎侧方减压术(FECF)和微内镜下颈椎侧方减压术(MECF)是治疗神经根型颈椎病的有效手术,在脊柱旁软组织损伤方面被认为是微创的。然而,目前尚无研究从神经侵入性方面对 FECF 和 MECF 进行定量比较。本研究旨在通过术中运动诱发电位(MEP)监测比较 FECF 和 MECF 的神经侵入性。

对 2014 年 4 月至 2020 年 3 月期间接受 FECF 或 MECF 治疗的 224 例神经根型颈椎病患者进行了病历回顾。患者中女性 37 例,男性 187 例,平均年龄 51 岁(范围 21-86 岁)。其中 FECF 组 143 例,MECF 组 81 例。

FECF 组患者神经根减压前平均 MEP 振幅为 292 mV,减压后为 677 mV,平均增幅为 273%。MECF 组患者神经根减压前平均 MEP 振幅为 306 mV,减压后为 432 mV,平均增幅为 130%。FECF 组的改善率明显高于 MECF 组。

FECF 和 MECF 两组患者神经根减压后 MEP 振幅均增加,但 FECF 组的改善率更高。这些结果表明,在神经方面,FECF 可能比 MECF 更微创。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7093/7698079/50050331fe36/medicina-56-00605-g001.jpg

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