单侧双通道内镜下后路椎管减压及髓核摘除术治疗脊髓型颈椎病的临床疗效

Clinical efficacy of unilateral biportal endoscopic posterior spinal canal decompression and discectomy for cervical spondylotic myelopathy

中文关键词:  单侧双通道内镜  脊髓型颈椎病  微创手术  临床疗效

英文关键词:Unilateral biportal endoscopy  Cervical spondylotic myelopathy  Minimally invasive surgery  Clinical efficacy

中文摘要:

  【摘要】 目的：探讨单侧双通道内镜（unilateral biportal endoscopy，UBE）下经后路手术治疗脊髓型颈椎病（cervical spondylotic myelopathy，CSM）的临床疗效及安全性。方法：回顾性分析2021年8月~2023年6月于无锡市第九人民医院脊柱外科接受UBE下颈椎管减压及髓核摘除手术的24例CSM患者临床资料，男性9例，女性15例，病变节段：C3/4 2例，C4/5 5例，C5/6 14例，C6/7 7例；单节段20例，双节段4例。记录手术时间、透视次数、住院天数、并发症及影像学结果。随访时间为20～24个月。术前、术后3个月及末次随访时进行影像学检查，并采用日本骨科协会（Japanese Orthopaedic Association，JOA）评分、视觉模拟量表（visual analogue scale，VAS）评分、颈椎功能障碍指数（neck disability index，NDI）评估神经功能和疼痛程度。结果：24例患者均顺利完成手术。术后3个月及末次随访时，JOA评分分别为12（11.5，12）分、15（15，16）分，与术前（6.39±0.97分）相比差异有统计学意义（P<0.05）；VAS评分分别为2（1，2）分、0（0，1）分，与术前的3（3，4）分相比差异有统计学意义（P<0.05）；NDI分别为（20.17±3.58）%、（4.09±1.82）%，与术前的46%（40%，50%）相比，差异有统计学意义（P<0.05）。术后影像学复查示颈椎曲度良好，脊髓受压情况显著缓解，均未出现颈椎不稳。术后1例患者发生硬脊膜撕裂，未行硬脊膜修补，给予明胶海绵覆盖，术后未见明显脑脊液漏；1例患者术后症状无明显改善，对症治疗3个月后选择开放手术治疗。结论：UBE下经后路椎管减压及髓核摘除术治疗CSM能有效改善脊髓受压情况，缓解疼痛，并具有微创、恢复快的优势。

英文摘要:

  【Abstract】 Objectives: To investigate the clinical efficacy and safety of unilateral biportal endoscopy(UBE) technique via the posterior approach in the treatment of cervical spondylotic myelopathy(CSM). Methods: A retrospective analysis was conducted on the clinical data of 24 CSM patients who underwent cervical spinal canal decompression and discectomy via UBE surgery in the Department of Spine Surgery, Wuxi Ninth People′s Hospital from August 2021 to June 2023. There were 9 males and 15 females. Affected segments: C3/4 in 2 cases, C4/5 in 5 cases, C5/6 in 14 cases, and C6/7 in 7 cases. There were 20 cases of single-segment and 4 cases of double-segment involvement. Operation time, fluoroscopy frequency, length of hospital stay, complications, and imaging results were recorded. The patients were followed up for 20-24 months. The Japanese Orthopaedic Association(JOA) score, visual analogue scale(VAS) for pain, and neck disability index(NDI) were used to assess neurological function and pain levels before operation, at postoperative 3 months and final follow-up, meanwhile, imaging examinations were performed. Results: All 24 patients successfully underwent UBE surgery. At 3 months postoperatively and final follow-up, the JOA score was 12(11.5，12) and 15(15, 16), which was statistically different from the preoperative score of 6.39±0.97(P<0.05); The VAS score was 2(1, 2) and 0(0, 1) respectively, statistically different from the preoperative score of 3(3, 4)(P<0.05); The NDI was (20.17±3.58)% and (4.09±1.82)% respectively, statistically different from the preoperative index of 46%(40%, 50%)(P<0.05). Postoperative imaging showed good cervical curvature and significant relief of spinal cord compression, with no cervical instability observed. Postoperative complications included one case of dural tear, which was not directly repaired but covered with gelatin sponge; no obvious cerebrospinal fluid leakage was observed. One patient showed no significant improvement in symptoms postoperatively and opted for open surgery after 3 months of symptomatic treatment. Conclusions: The UBE technique -assisted posterior spinal canal decompression and discectomy for treating CSM can effectively relieve spinal cord compression and alleviate pain, with advantages of being minimally invasive and promoting rapid recovery.