Early clinical efficacy of L-unitary soft endoscope assisted anterior cervical discectomy and fusion for 3-level cervical spondylosis

English Keywords:Cervical spondylosis  Anterior cervical discectomy and fusion  Soft endoscope  Minimally invasive spine surgery

English Abstract:

  【Abstract】 Objectives: To investigate the early clinical efficacy and safety of L-unitary soft endoscope-anterior cervical discectomy and fusion(LUSE-ACDF) for the treatment of 3-level cervical spondylosis. Methods: The medical records of 53 patients with cervical spondylosis who underwent 3-level ACDF at our hospital between January 2019 and March 2025 were retrospectively analyzed. 26 patients treated with LUSE-ACDF were assigned to the LUSE group(17 males and 9 females, with an average age of 62.8±12.7 years), while 27 patients treated with conventional ACDF were assigned to the conventional group(11 males and 16 females, with an age of 58.5±10.6 years). There were no significant differences between the two groups in baseline characteristics, including age, gender, and operative segment(P>0.05). Perioperative parameters, including operative time, intraoperative blood loss, postoperative drainage volume, time to ambulation, postoperative length of hospital stay, and complications were compared between the two groups. Clinical efficacy was evaluated using the visual analogue scale(VAS), Japanese Orthopaedic Association(JOA) score, and neck disability index(NDI) at preoperation, postoperative 3d, and final follow-up visits. Radiographic parameters, including anterior and posterior vertebral body heights, surgical segment Cobb angle, and C2-C7 Cobb angle were measured preoperatively and at final follow-up on lateral cervical radiographs. Results: All the patients successfully completed the surgery, and were followed up for 10.3±2.9 months. The LUSE group showed significantly lower postoperative drainage volume than the conventional group[25.0(5.0, 51.0)mL vs 40.0(30.0, 60.0)mL, P=0.024]. There were no significant differences between the two groups in terms of operative time[104.0(86.0, 133.5)min vs 115.0(95.0, 120.0)min] , intraoperative blood loss[40.0(20.0, 50.0)mL vs 45.0(20.0, 50.0)mL], time to ambulation[20.5(17.8, 23.5)h vs 20.0(17.0, 23.0)h], or postoperative length of hospital stay[5.5(4.0, 7.0)d vs 5.0(4.0, 7.0)d](P>0.05). Both groups showed significant improvements in VAS, JOA, and NDI scores at postoperative 3d and final follow-up compared to baseline(P<0.001), with no significant differences between the two groups at the same time points(P>0.05). Both groups demonstrated significant improvements in anterior and posterior vertebral body heights, surgical segment Cobb angle, and C2-C7 Cobb angle(P<0.001) after operation, with no significant differences between the two groups at the same time points(P>0.05). The conventional group had one case of epidural hematoma, and after emergency evacuation, the neurological symptoms of the patient improved; No other complications such as dysphagia, nerve injury, or cerebrospinal fluid leakage were observed. Conclusions: The LUSE-ACDF demonstrates satisfactory clinical outcomes in treating 3-level cervical spondylosis, which is a safe and effective minimally invasive technique.