Efficacy of endoscopic anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy with single-segment cervical instability

English Keywords:Cervical spondylosis myelopathy  Spinal unstable  Spinal endoscopy assistance  Anterior cervical discectomy and bone graft fusion  Efficacy analysis

English Abstract:

  【Abstract】 Objectives: To explore the clinical efficacy of endoscopic anterior cervical discectomy and fusion(Endo-ACDF) in the treatment of cervical spondylotic myelopathy(CSM) complicated with cervical instability. Methods: A retrospective analysis was conducted on the clinical data of 42 patients with single-segment cervical instability combined with CSM, who were diagnosed via dynamic cervical X-ray and MRI and underwent surgical treatment in our hospital from December 2022 to December 2024. Among the patients, 20 cases treated with Endo-ACDF were enrolled in the observation group(13 males and 7 females; mean age: 52.25±12.24 years old), and 22 patients treated with conventional open ACDF were included in the control group(11 males and 11 females; mean age: 52.82±10.17 years old). Preoperatively, all patients received dynamic cervical X-ray and MRI examinations to evaluate segmental instability and dynamic spinal cord compression. Perioperative indicators(operation time, intraoperative blood loss), Japanese Orthopaedic Association(JOA) scores, visual analogue scale(VAS) scores for shoulder and neck, and changes in the C2-7 Cobb angle before operation as well as at 3, 6 and 12 months after operation were compared between the two groups. The incidence of complications was also recorded. Results: Operations were successfully completed in both groups. The observation group was significantly less in intraoperative blood loss(13.50±1.31mL vs 32.96±5.53mL, P<0.05), while longer in operation time(120.65±3.23min vs 97.50±3.60min, P<0.05) than the control group. The JOA scores and VAS scores of both groups at each postoperative time point were significantly improved compared with those before operation(P<0.05). There were no statistically significant differences in JOA scores, VAS scores and C2-7 Cobb angle between the two groups at the same time point(P>0.05). The complication rate of the observation group was 5.00%(1/20), which was obviously lower than 18.18%(4/22) of the control group, without statistical difference(P>0.05). Conclusions: For CSM patients with single-segment cervical instability, Endo-ACDF can achieve equivalent neurological function improvement and cervical curvature restoration as open surgery. Meanwhile, it presents minimally invasive advantages including less intraoperative blood loss and a relatively lower complication rate.