Clinical application of posterior percutaneous endoscopic cervical discectomy in the treatment of cervical spondylotic radiculopathy

English Keywords:Posterior approach  Percutaneous  Endoscopic  Cervical discectomy  Cervical spondylotic radiculopathy

English Abstract:

  【Abstract】 Objectives: Through clinical comparative study, the clinical application value and advantages and disadvantages of posterior percutaneous endoscopic cervical discectomy(PPECD) in the treatment of radicular cervical spondylosis were evaluated. Methods: A prospective study. A total of 43 patients who were treated for cervical spondylotic radiculopathy between January 2013 and October 2016 were prospectively included in the study and obtained at least 1-year follow-up. The patients were randomly divided into the anterior cervical discectomy and fusion(ACDF) group with 23 patients and the PPECD group with 20 patients, follow-up for 23.1±5.9 month and 25.6±8.3 month respectively. The patient′s surgical time, length of hospitalization, inpatients expenses, pre-operative and post-operative upper limb VAS, surgical incision VAS, pre- and post-operative 1-year cervical Cobb angle, cervical motion range, neck disability index(NDI) score, rate of cervical axis symptom, the time return to work and post-operative 1-year Macnab score was analyzed. Results: The difference in surgical time was statistically insignificant(P＞0.05). At post-operative 1d, the upper limp VAS changed from 7.13±1.25 to 1.37±0.71 for the ACDF group and from 7.28±1.30 to 1.45±0.81 for the PPECD group. The change between pre- and post-operation upper limb VAS was statistically significant(P<0.05), but the difference between both groups at post-operative 1d was statistically insignificant(P>0.05). At post-operative 1d, the difference in surgical incision VAS was statistically significant(P<0.05) where the ACDF group(3.87±1.19) was greater than the PPECD group(1.91±0.58). However, at post-operative 1 week, the difference in surgical incision VAS was statistically insignificant(P>0.05). The length of hospital stays, inpatient expenses and the time return to work in PPECD group was significantly lower than ACDF group(P<0.05). The pre- and post-operative 1-year cervical Cobb angle for the ACDF group was 4.3°±11.3° and 13.7°±6.9° respectively; the difference was statistically significant(P<0.05) whereas pre- and post-operative 1-year cervical Cobb angle for the PPECD group was 4.7°±8.9° and 8.2°±4.8° respectively where the difference was statistically insignificant(P>0.05). The range of cervical motion in ACDF group decreased significantly(P>0.05) but in the PPECD group, no obvious decrease in range of motion was observed(P>0.05). The NDI score, rate of post-operation cervical axis symptom and Macnab score in both groups showed no difference at post-operative 1 year follow-up(P>0.05). Conclusions: The clinical effectiveness of PPECD and ACDF in treating cervical spondylotic radiculopathy is equivalent. However, PPECD can be favored due to the surgical incision, inpatient expenses, post-operative recovery.