Department of Rehabilitation, The Affiliated Hospital of Southwest Medical University, Luzhou, Sichuan, China.
Department of Hospital Infection Control, The First People's Hospital of Zunyi, Zunyi, Guizhou, China.
Pain Physician. 2021 Sep;24(6):E811-E819.
Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited.
To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application.
A retrospective cohort study.
A center for spine surgery, rehabilitation department and pain medicine.
Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations.
The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body.
This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design.
Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results.
The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820).
目前鲜少有经皮全内镜前路经椎体颈椎间盘切除术（PEATCD）的相关研究，因此，关于 PEATCD 的手术设计及相关临床结果的数据非常有限。
设计 PEATCD 的手术方案并评估其在临床应用中的疗效。
回顾性队列研究。
脊柱外科中心、康复科和疼痛医学科。
根据 MRI 上椎间盘突出的大小和精确位置，设计骨通道的直径和方向，制定 PEATCD 的手术方案。2015 年 10 月至 2016 年 9 月，共有 26 例中央/旁中央颈椎间盘突出症（CDH）患者采用设计的手术方案行经皮全内镜前路经椎体颈椎间盘切除术，纳入本回顾性研究。临床疗效评估包括视觉模拟评分（VAS）、日本骨科协会（JOA）评分和改良 Macnab 标准。影像学随访包括颈椎计算机断层扫描（CT）和 MRI 评估。
设计的骨通道直径约 7.5mm，方向为自下终板上缘斜向椎间盘突出物。通过设计的手术方案，26 例椎间盘切除术均顺利完成。平均手术时间为 91.50±16.80min，平均住院时间为 4.07±0.84d。所有患者平均随访 19.61±4.04 个月。与术前相比，术后 VAS 和 JOA 评分均显著改善（P<0.0001）。末次随访时采用改良 Macnab 标准评估临床疗效，优良率为 92.31%。术后 MRI 显示椎间盘突出物完全切除，CT 显示椎体无塌陷。
本研究存在一些局限性，包括缺乏对照组、样本量小以及单中心研究设计的固有性质。
根据 MRI 上椎间盘突出的大小和位置，设计骨通道的直径和方向，有利于在全内镜视野下有足够的空间充分暴露和切除椎间盘突出物，避免残留，确保 PEATCD 取得良好的治疗效果。
本研究在中国临床试验注册中心注册（ChiCTR1900027820）。
