Department of Minimally Invasive Spinal Surgery, Angang General Hospital, Middle Section of Gangsan Road, Yindu District, Anyang, 445000, China.
J Orthop Surg Res. 2024 Jan 5;19(1):35. doi: 10.1186/s13018-023-04514-w.
In this study, we compared the clinical efficacy of endoscope-assisted anterior cervical discectomy and fusion (ACDF) with open ACDF in the treatment of single-segment cervical spondylotic myelopathy.
A retrospective analysis was performed on 52 patients with single-segment cervical spondylotic myelopathy between June 2021 and February 2022, including 33 males and 19 females, with a mean age of 58.42 ± 9.26) years. Among them, 28 patients were treated with endoscope-assisted ACDF (Group A), including 2 cases of C4/5 segment, 16 cases of C5/6 segment, and 10 cases of C6/7 segment; 24 patients were treated with open ACDF (Group B), including 4 cases of C4/5 segment, 11 cases of C5/6 segment, and 9 cases of C6/7 segment. The operation time, intraoperative blood loss, hospital stay, and complications were recorded and compared between the two groups. The Visual Analogue Scale (VAS) and the Japanese Orthopaedic Association (JOA) score were used for clinical evaluation during the follow-up in the 1st month and 3rd month after surgery, and at the final follow-up.
The 52 patients were followed up on average for 13.04 months (12-17 months). The operation time in Group A and Group B was (105.18 + 8.66) minutes and (81.88 + 6.05) minutes, the intraoperative blood loss was (84.29 + 13.45) mL and (112.92 + 17.81) mL, and the hospital stay was (6.75 + 1.29) days and (7.63 + 1.41) days, respectively. The difference between the two groups was statistically significant (P < 0.05). The VAS and JOA scores in the 1st month and the 3rd month after surgery and the last follow-up significantly improved in both groups compared with those before surgery (P < 0.05). The VAS and JOA scores of Group A in the 1st month, 3rd month after surgery, and the last follow-up were better than those in Group B (P < 0.05). The complication rate in Group A was 7% (2/28), which was not significantly different from the 17% (4/24) in Group B (P > 0.05).
Both endoscope-assisted ACDF and open ACDF can achieve satisfactory clinical efficacy in the treatment of single-segment cervical spondylotic myelopathy. Although the operation time of endoscope-assisted ACDF is prolonged, it has the advantages of clear vision, thorough decompression, less blood loss, and reduced risk of nerve damage, and is worthy of clinical promotion and application.
本研究对比了内镜辅助下前路颈椎间盘切除融合术（ACDF）与开放 ACDF 治疗单节段脊髓型颈椎病的临床疗效。
回顾性分析 2021 年 6 月至 2022 年 2 月收治的 52 例单节段脊髓型颈椎病患者，男 33 例，女 19 例；年龄 58.42±9.26）岁。其中 28 例行内镜辅助 ACDF（A 组），包括 C4/5 节段 2 例，C5/6 节段 16 例，C6/7 节段 10 例；24 例行开放 ACDF（B 组），包括 C4/5 节段 4 例，C5/6 节段 11 例，C6/7 节段 9 例。记录并比较两组患者的手术时间、术中出血量、住院时间及并发症。术后第 1 个月、3 个月及末次随访时采用视觉模拟评分（VAS）和日本骨科协会（JOA）评分评估临床疗效。
52 例患者平均随访 13.04 个月（12～17 个月）。A 组和 B 组手术时间分别为（105.18±8.66）min 和（81.88±6.05）min，术中出血量分别为（84.29±13.45）mL 和（112.92±17.81）mL，住院时间分别为（6.75±1.29）d 和（7.63±1.41）d，两组比较差异有统计学意义（P＜0.05）。两组患者术后第 1 个月、3 个月及末次随访时 VAS 和 JOA 评分均较术前显著改善（P＜0.05），且 A 组 VAS 和 JOA 评分在术后第 1 个月、3 个月及末次随访时均优于 B 组（P＜0.05）。A 组并发症发生率为 7%（2/28），与 B 组的 17%（4/24）比较差异无统计学意义（P＞0.05）。
内镜辅助 ACDF 与开放 ACDF 治疗单节段脊髓型颈椎病均能取得满意的临床疗效，内镜辅助 ACDF 虽然手术时间延长，但具有视野清晰、减压彻底、出血量少、神经损伤风险低等优点，值得临床推广应用。
