后路经皮内镜下颈椎间盘切除术治疗颈椎融合术后邻椎病的疗效分析

Efficacy analysis of posterior percutaneous endoscopic cervical discectomy in treating adjacent segment disease after cervical fusion

中文关键词:  脊柱内镜  颈椎融合术  邻椎病  神经根型颈椎病  临床疗效

英文关键词:Spinal endoscopy  Cervical fusion  Adjacent segment disease  Cervical spondylotic radiculopathy  Clinical efficacy

中文摘要:

  【摘要】 目的：探讨后路经皮内镜下颈椎间盘切除术（posterior percutaneous endoscopic cervical discectomy，PPECD）治疗颈椎前路融合术后出现神经根压迫症状的邻椎病（adjacent segment disease，ASD）的临床疗效。方法：回顾性分析2018年6月～2023年6月在我院脊柱外科收治的12例颈椎前路融合术后邻椎病患者，男7例，女5例，平均年龄58.2±18.1岁。纳入标准为出现单纯神经根压迫症状，且所有患者均接受PPECD手术治疗。记录患者的一般资料、手术时间、术中出血量、住院时间及并发症情况。分别在术前、术后1d、术后3个月和末次随访时采用疼痛视觉模拟量表（visual analog scale，VAS）评分、日本骨科协会（Japanese Orthopaedic Association，JOA）评分及颈部功能障碍指数（neck disability index，NDI）评估神经功能及疼痛改善情况。临床疗效依据Odom标准及JOA改善率进行评价。通过颈椎动力位X线片测量手术节段活动度（range of motion，ROM），侧位X线片测量手术节段椎间隙高度，比较术前与末次随访时的影像学变化。结果：所有患者均顺利完成PPECD手术，无1例中转开放手术。平均手术时间为85.8±15.6min，平均术中出血量为26.2±8.5mL，平均住院时间为5.5±1.0d。术后随访时间为24～68个月，平均37.1±15.2个月。术后1d、3个月及末次随访时，患者颈部及上肢VAS评分、NDI均较术前显著下降，JOA评分显著提高，差异均具有统计学意义（P<0.05）。同时，术后3个月及末次随访的各项评分均较术后1d进一步改善，差异有统计学意义（P<0.05）。末次随访时，根据Odom标准，临床疗效优良率为91.67%；JOA评分平均改善率为72.5%。手术节段ROM及椎间隙高度在术前与末次随访时比较，差异无统计学意义（P>0.05）。所有病例术中及术后均未出现脊髓神经损伤、椎动脉损伤或切口感染等严重并发症。结论：PPECD是治疗颈椎融合术后出现神经根压迫症状的邻椎病的一种安全、有效的微创手术方式，能有效缓解神经压迫症状，改善患者功能，且对手术节段稳定性影响较小，近期疗效满意。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy of posterior percutaneous endoscopic cervical discectomy(PPECD) in treating adjacent segment disease(ASD) with nerve root compression symptoms after anterior cervical fusion surgery. Methods: This study retrospectively analyzed 12 patients with ASD after anterior cervical fusion surgery admitted to our Spinal Surgery Department from June 2018 to June 2023. There were 7 male cases and 5 female cases, with an average age of 58.2±18.1 years. The patients inclusion criteria were the occurrence of simple nerve root compression symptoms and receiving PPECD treatment. The general data, operative time, intraoperative blood loss, hospital stay, and complications were recorded. At preoperation, 1d postoperation, 3 months postoperation and at final follow-up. Pain was assessed using the visual analog scale(VAS), neurological function was evaluated with the Japanese Orthopaedic Association(JOA) score, and functional status was measured by the neck disability index(NDI). Clinical outcomes were graded according to Odom′s criteria and JOA improvement rates. Radiographic evaluation included measurement of segmental range of motion(ROM) from dynamic cervical radiographs and disc space height from lateral radiographs before operation and at final follow-up. Results: All patients successfully underwent PPECD without conversion to open surgery. The mean operative time was 85.8±15.6min, mean intraoperative blood loss was 26.2±8.5mL, and mean hospital stay was 5.5±1.0d. The follow-up period ranged from 24 to 68 months(mean, 37.1±15.2 months). At postoperative 1d, 3 months, and final follow-up, significant improvements were observed in neck and upper limb VAS scores, NDI, and JOA scores compared to preoperative values(P<0.05). Furthermore, scores at 3 months and final follow-up showed further improvement compared to those at 1d postoperatively(P<0.05). At the final follow-up, the excellent-to-good rate according to Odom′s criteria was 91.67%, and the mean JOA improvement rate was 72.5%. No statistically significant differences were found in segmental ROM or disc space height between preoperative and final follow-up measurements(P>0.05). No serious intraoperative or postoperative complications, such as spinal cord or nerve injury, vertebral artery injury, or surgical site infection, occurred. Conclusions: PPECD is a safe and effective minimally invasive surgical technique for the treatment of ASD presenting with nerve root compression after cervical fusion. It effectively alleviates nerve compression symptoms, improves patient function, and has minimal impact on the stability of the surgical segment, yielding satisfactory short-to-midterm outcomes.