Department of Orthopaedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China.
Curr Med Sci. 2020 Dec;40(6):1170-1176. doi: 10.1007/s11596-020-2299-5. Epub 2021 Jan 11.
Endoscopic cervical foraminotomy is increasingly used for cervical spondylotic radiculopathy (CSR), but there is great concern about radiation exposure because of the heavy dependence of this surgical method on fluoroscopy. The objective of this study was to introduce in detail an advanced surgical technique of keyhole foraminotomy via a percutaneous posterior full-endoscopic approach as a treatment for CSR and investigate its clinical outcomes. We retrospectively reviewed 33 consecutive patients with CSR who underwent keyhole foraminotomy via a percutaneous posterior full-endoscopic approach from October 2015 to April 2017. The patients' general characteristics, including operative time, blood loss, hospital stay, complications, and recurrence, were obtained. Clinical outcomes were evaluated using the visual analogue scale (VAS) for radicular pain, the neck disability index (NDI) for functional assessment, and the modified MacNab criteria for patient satisfaction. All operations were successfully performed (mean operation time, 62 min), with no measurable blood loss or severe related complications. The mean follow-up was 25 months. The VAS and NDI scores were significantly improved as compared with those in the preoperative period (preoperative vs. final follow-up: 7.6±1.6 vs. 3.83±7.34 for VAS, P<0.01; 69.5%±10.5% vs. 17.54%±13.40% for NDI, P<0.01). Of the 33 patients, 32 (97.0%) had good-to-excellent global outcomes and all patients obtained symptomatic improvement. In conclusion, keyhole foraminotomy via a percutaneous posterior full-endoscopic approach is an efficient, safe, and feasible procedure for the treatment of CSR. Its simplified single-step blunt incision for localization appears to decrease radiation exposure risks.
经皮后路全内镜下颈椎侧方椎间孔切开术日益应用于治疗神经根型颈椎病（CSR），但由于该手术方法严重依赖透视，故人们对其辐射暴露问题存在较大担忧。本研究的目的是详细介绍一种通过经皮后路全内镜下小切口颈椎侧方椎间孔切开术（keyhole foraminotomy）治疗 CSR 的先进手术技术，并探讨其临床效果。我们回顾性分析了 2015 年 10 月至 2017 年 4 月期间采用经皮后路全内镜下小切口颈椎侧方椎间孔切开术治疗的 33 例 CSR 患者。获取了患者的一般特征，包括手术时间、出血量、住院时间、并发症和复发情况。采用根性疼痛视觉模拟量表（VAS）、颈部残疾指数（NDI）评估功能、改良 MacNab 标准评估患者满意度来评估临床疗效。所有手术均顺利完成（平均手术时间 62 分钟），术中无明显失血，无严重相关并发症。平均随访时间为 25 个月。与术前相比，VAS 和 NDI 评分均显著改善（术前 vs. 末次随访：7.6±1.6 vs. 3.83±7.34，P<0.01；69.5%±10.5% vs. 17.54%±13.40%，P<0.01）。33 例患者中，32 例（97.0%）获得了良好至优秀的整体疗效，所有患者的症状均得到改善。综上所述，经皮后路全内镜下颈椎侧方椎间孔切开术是治疗 CSR 的一种有效、安全且可行的方法。其简化的单步钝性切口定位似乎降低了辐射暴露风险。
