Clinical efficacy of O-arm navigation assisted percutaneous endoscopic Key-hole procedure in single-segment cervical spondylotic radiculopathy

English Keywords:O-arm navigation  Spinal endoscopy  Key-hole procedure  Cervical spondylotic radiculopathy

English Abstract:

  【Abstract】 Objectives: To evaluate the clinical efficacy of O-arm navigation assisted percutaneous endoscopic Key-hole procedure in single-segment cervical spondylotic radiculopathy(CSR). Methods: Data of 22 patients with single-segment CSR treated with O-arm navigation-assisted posterior percutaneous endoscopic cervical foraminotomy(PPECF), the Key-hole procedure in our hospital from September 2018 to June 2020 were retrospectively analyzed. There were 14 males and 8 females, aged 54.05±10.67 years（32-71 years）, including 8 cases of C5/6, 13 cases of C6/7 and 1 case of C7/T1. Operative time, intraoperative blood loss, length of hospital stay, and complications were recorded; Visual analogue scale(VAS) and neck disability index(NDI) were used for pain and functional assessment before surgery, at 3d after surgery and the last follow-up; And efficacy was assessed according to modified Macnab criteria at the last follow-up. X-ray, CT and MRI were performed before operation, at 3d after operation and final follow-up. The disc height(DH), cervical spinal angle(CSA) and the facet resection rate(FRR) were measured for imaging evaluation. Results: All patients were successfully operated and followed up for 36.86±5.83 months(25-44 months). The average operative time was 120.32±33.92mins(76-209mins), the intraoperative blood loss was 14.86±12.67ml(2-50ml), and the postoperative length of hospital stay was 4.05±1.70d(2-9d). 3 patients developed complications, including 1 case of right tricep muscle strength decreased to grade 2 due to C7 nerve root injury during operation which recovered to grade 5 at final follow-up; One case suffered from vertebral artery clamp injury and bleeding during operation which was treated with gel sponge immediately to stop bleeding, and postoperative imaging showed no hematoma formation; One patient developed mild neuralgia after surgery and improved with medication. Both the last follow-up VAS score and NDI were significantly improved compared with those before surgery(P<0.05). According to modified MacNab criteria, the excellent and good rate was 95.5%, of which 17 cases were excellent, 4 cases were good, and 1 case was medium. The preoperative, postoperative and final follow-up DHs were 4.40±0.97mm, 4.31±0.92mm and 4.26±1.01mm, and CSAs were 5.70°±16.94°, 8.43°±15.59° and 11.44°±13.80°. There was no significant difference between the preoperative, postoperative and final follow-up DHs and CSA(P>0.05). The FRR was (27.12±16.62)%. Conclusions: O-arm navigation assisted percutaneous endoscopic Key-hole procedure is safe and effective in the treatment of CSR, which has the advantages of accurate insertion of working cannula and reduction of surgical injury.