Department of Spine Surgery, The Third Hospital of Hebei Medical University, Hebei, China.
BMC Musculoskelet Disord. 2023 Jul 15;24(1):578. doi: 10.1186/s12891-023-06713-2.
To compare the clinical efficacy of surgical treatment for multilevel cervical spondylotic myelopathy (MCSM) between the hybrid procedure, posterior endoscopic decompression (PED) combined with anterior cervical discectomy fusion (ACDF), and posterior cervical laminectomy and fusion (PCLF).
A retrospective analysis was performed on 38 patients who received surgical treatment for MCSM from January 2018 to December 2021, including 19 cases in hybrid procedure group (13 males and 6 females), followed up for 10 to 22 (12.8 ± 10.3) months, and 19 cases in PCLF group (15 males and 4 females), followed up for 10 to 21 (11.7 ± 8.9) months. Perioperative information, including operation time, intraoperative blood loss, length of hospitalization, and complications, were compared between two groups. Visual analogue scale (VAS) of pain, neck disability index (NDI) and Japanese Orthopaedic Association (JOA) score were recorded to evaluate clinical efficacy. Cervical lordosis was calculated by radiographic examination.
Intraoperative blood loss, length of hospital stay were less in hybrid group than PCLF group, while operation time is longer in hybrid group, with a statistically significant difference (p < 0.05). Increased lordosis was better in hybrid group. There was no significant difference in preoperative VAS, JOA and NDI at pre-operation and final follow-up between two groups. But at post-operation and final follow-up, VAS was less in hybrid group than PCLF group (p < 0.05). There were 2 cases of neurostimulation symptoms in hybrid group, 2 cases of C5 nerve root palsy, 2 cases of subcutaneous fat necrosis and 1 case of dural tear in PCLF group, and all patients relieved with symptomatic treatment.
The hybrid procedure of PED combined with ACDF showed satisfied clinical outcome, with less intraoperative blood loss, shorter length of hospitalization and lower post-operative neck pain than PCLF. It is an effective surgical treatment for MCSM.
比较杂交手术（PED 联合 ACDF）与颈椎后路减压融合术（PCLF）治疗多节段脊髓型颈椎病（MCSM）的临床疗效。
回顾性分析 2018 年 1 月至 2021 年 12 月收治的 38 例 MCSM 患者的临床资料，其中杂交手术组 19 例（男 13 例，女 6 例），随访 1022 个月，平均（12.8±10.3）个月；PCLF 组 19 例（男 15 例，女 4 例），随访 1021 个月，平均（11.7±8.9）个月。比较两组患者的手术时间、术中出血量、住院时间、并发症等围手术期指标，采用视觉模拟评分法（VAS）、颈椎功能障碍指数（NDI）和日本骨科协会（JOA）评分评估临床疗效，影像学检查评估颈椎曲度。
杂交手术组术中出血量、住院时间少于 PCLF 组，手术时间长于 PCLF 组，差异有统计学意义（p<0.05）。杂交手术组颈椎曲度增加优于 PCLF 组。两组患者术前及末次随访时 VAS、JOA、NDI 比较差异无统计学意义，术后及末次随访时 VAS 评分杂交手术组低于 PCLF 组，差异有统计学意义（p<0.05）。杂交手术组术后发生神经刺激征 2 例、C5 神经根麻痹 2 例、皮下脂肪坏死 2 例、硬脊膜撕裂 1 例，均经对症治疗后缓解；PCLF 组术后发生神经刺激征 1 例，经对症治疗后缓解。
PED 联合 ACDF 杂交手术治疗 MCSM 可获得满意的临床疗效，术中出血量少、住院时间短、术后颈部疼痛轻。
