Comparison of clinical efficacies between three endoscopic surgeries in treating cervical spondylotic radiculopathy

English Keywords:Cervical spondylotic radiculopathy  Uniportal endoscopy  Unilateral biportal endoscopy  Hybrid technique

English Abstract:

  【Abstract】 Objectives: To propose a hybrid technique(HT) combining unilateral biportal endoscopy(UBE) and double working channel spinal endoscopy and to compare uniportal endoscopic surgery(UES), UBE and HT in the treatment of cervical spondylotic radiculopathy(CSR). Methods: The clinical data of 63 CSR patients treated in Shanghai General Hospital with either UES, UBE, or HT between September 2019 and August 2021 were analyzed retrospectively. Among the patients, 21 were treated with UES(UES group, 11 males and 10 females, aged 43.19±9.83 years) involving C4/5 in 7 cases, C5/6 in 10 cases, and C6/7 in 4 cases; 19 were treated with UBE(UBE group, 8 males and 11 females, aged 45.05±10.73 years) involving C4/5 in 6 cases, C5/6 in 11 cases, and C6/7 in 2 cases; 23 were treated with HT(HT group, 12 males and 11 females, aged 46.78±11.38 years) involving C4/5 in 9 cases, C5/6 in 11 cases, and C6/7 in 3 cases. The operative time, intraoperative bleeding coefficient, and length and cost of hospital stay were collected, and the decompression range and soft tissue reaction band were observed on CT and MRI before operation and on postoperative 3d. At preoperation, postoperative 3d, 3 and 6 months, visual analogue scale(VAS) was employed to evaluate the neck and shoulder pain and upper limb nerve root pain, neck disability index(NDI) was used to assess cervical function, and modified Macnab criteria were adopted to evaluate clinical efficacy at postoperative 6 months. Results: All the patients were followed up for 6 months. The operative time in UBE group(58.95±5.40min) and HT group(63.57±8.05min) were significantly shorter than the UES group(72.33±9.13min)(P<0.05). The intraoperative bleeding coefficient and length of hospital stay were significantly greater in the UBE group(1.61±0.21, 5.84±0.67d) than those in the UES group(1.11±0.16, 4.62±0.65d) and HT group(1.37±0.12, 4.56±0.66d)(P<0.05). On 3 days after surgery, the soft tissue reaction band was larger in the UBE(7.49±0.88cm2) and HT group(7.22±0.43cm2) than that in the UES group(5.01±0.41cm2). The postoperative VAS and NDI decreasd significantly compared with the preoperative ones respectively in all the three groups(P<0.05). The VAS for neck and shoulder pain was significantly higher in the UBE group(3.89±0.97) and HT group(3.83±0.72) than that in the UES group(2.81±0.73)(P<0.05). However, there were no significant differences in the VAS for arm pain or the NDI between the three groups(P>0.05). The neck and shoulder pain VAS, arm pain VAS, NDI at postoperative 3-month and 6-month, and excellent and good rate of modified Macnab criteria at postoperative 6-month did not differ statistically in all the three groups, respectively(P>0.05). Conclusions: The three kinds of endoscopic surgeries all can achieve satisfactory clinical efficacies in treating CSR. The three endoscopic surgeries have their own advantages and disadvantages, which can be selected according to the actual situation in clinic.