颈椎后路内窥镜下椎间盘切除术治疗单节段神经根型颈椎病

Posterior microendoscopic discectomy for single-level cervical spondylotic radiculopathy

中文关键词:  神经根型颈椎病  内窥镜下椎间盘切除术  单节段

英文关键词:Cervical spondylotic radiculopathy  Microendoscopic discectomy  Single-level

中文摘要:

  【摘要】 目的：探讨颈椎后路内窥镜下椎间盘切除术（microendoscopic discectomy，MED）治疗单节段神经根型颈椎病（cervical spondylotic radiculopathy，CSR）的临床疗效。方法：2010年9月～2012年8月，我科采用颈椎后路MED治疗单节段神经根型颈椎病患者16例，其中男11例，女5例；年龄31～56岁，平均41.7岁；C4/5 4例，C5/6 9例，C6/7 3例；均为一侧根性症状，CT、MRI等影像学检查提示单节段外侧突出或/和关节突增生致椎间孔狭窄，神经受压节段与临床症状体征相符， 经系统保守治疗6周以上无效，颈椎动力位X线片未见颈椎不稳。随访观察患者的颈痛VAS评分、JOA评分、颈椎生理曲度、颈椎病变节段稳定性和椎间高度的变化，并进行统计学分析。结果：平均手术时间89min（75～115min）；术中平均出血量85ml（30～160ml）；术后平均住院时间4.1d（3～7d）；出院时患者神经根性症状缓解11例，明显改善5例；16例均获随访，平均随访时间12.7个月（6～25个月），VAS评分由术前的7.13±1.15分降至术后的3.00±0.63分，末次随访时为1.94±0.85分；JOA评分由术前12.63±1.09分提高至15.63±0.50分，末次随访时为16.13±0.62分；术前、术后与末次随访时两两比较均有统计学意义（P<0.05）。颈椎生理曲度D值从术前7.66±0.99mm提高到末次随访时10.99±0.95mm，差异有统计学意义（P<0.05）。术前和末次随访时病变节段椎间高度分别为5.56±0.54mm和5.54±0.52mm，差异无统计学意义（P＞0.05）。过伸过屈位X线片未显示明显颈椎失稳。结论：在严格选择适应证的前提下，颈椎后路MED治疗单节段神经根型颈椎病可取得较满意的临床疗效。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical results of posterior microendoscopic discectomy for single-level cervical spondylotic radiculopathy. Methods: A retrospective review was performed on 16 patients with cervical spondylotic radiculopathy undergoing microendoscopic discectomy from September 2010 to August 2012. There were 11 males and 5 females with an average age of 41.7 years(range, 31-56 years). The level of herniation was C4/5 in 4 cases, C5/6 in 9 cases and C6/7 in 3 cases. All patients had clinical presentations and neurological examinations consistent with a single-level unilateral herniated nucleus pulposus, which was refractory to more than 6 weeks of conservative management. These diagnoses were determined by computed tomography scans and magnetic resonance imaging. Dynamic instability was verified under extension and flexion X-ray. Clinical efficacy was evaluated by VAS score, JOA score, cervical curvature, the stability and disc height at surgical segment. Results: The average operation time was 89min(range, 75-115min); the average blood loss during operation was 85ml(range, 30-160ml); the average length of hospital stay was 4.1 days(3-7 days). Radicular symptoms relieved in 11 cases and improved significantly in 5 cases when discharged. All cases were followed up for 6-25 months(average, 12.7 months). VAS decreased from 7.13±1.15 preoperatively to 3.00±0.63 postoperatively, and 1.94±0.85 at final follow-up, and JOA score increased from 12.63±1.09 preoperatively to 15.63±0.50 postoperatively, and 16.13±0.62 at final follow-up, which showed significant difference among the data of preoperation, postoperation and final follow-up(P<0.05). Cervical curvature increased from 7.66±0.99mm to 10.99±0.95mm at final follow-up, which showed significant difference(P<0.05). Disc height in surgical level of preoperation and at final follow-up was 5.56±0.54mm and 5.54±0.52mm respectively, which showed no significant difference(P＞0.05). No radiographic instability was revealed on dynamic radiographs after operation. Conclusions: Based on strict indication, satisfactory clinical results can be achieved by posterior microendoscopic discectomy with minimal invasion for single-level cervical spondylotic radiculopathy.