Early clinical efficacy of anterior cervical discectomy and fusion under soft endoscopic minimally invasive system for single-level cervical spondylotic myelopathy

English Keywords:Soft endoscope  Cervical spondylotic myelopathy  Anterior cervical discectomy and fusion  Minimally invasive

English Abstract:

  【Abstract】 Objectives: To explore the efficacy and safety of a novel L-unitary soft endoscopic anterior cervical discectomy and fusion(LUSE-ACDF) technique in the treatment of single-level cervical spondylotic myelopathy(CSM). Methods: A retrospective controlled analysis was conducted on the medical records of 48 patients with CSM who underwent single-level anterior cervical discectomy and fusion(ACDF) between August 2022 and November 2023. Among the patients, 24 were treated with LUSE-ACDF and were included in the LUSE-ACDF group, comprising 9 males and 15 females, with a mean age of 57.83±10.51 years; The remaining 24 underwent conventional ACDF and were included in the conventional ACDF group, comprising 11 males and 13 females, with a mean age of 54.33±14.78 years. There were no significant differences between the two groups in terms of baseline characteristics such as age, gender, height and weight(P>0.05). Data on operative time, incision length, intraoperative blood loss, duration of hospital stay, and the incidence of perioperative complications were collected and compared between the two groups of patients. Preoperatively and at 1 week, 1 month, 3 months and 6 months post-operatively, clinical efficacy was assessed using the Japanese Orthopaedic Association(JOA) score and visual analogue scale(VAS) for neck and shoulder pain. At 6 months post-operatively, fusion rates, C2-7 sagittal Cobb angle, anterior column height and minimum sagittal diameter of the spinal canal of the operative segment were measured and evaluated using CT/MRI. Results: All surgeries were successful with no perioperative complications observed during the follow-up period of this study. At the final follow-up, both the JOA score and VAS score in the LUSE-ACDF group showed significant improvement compared with preoperative levels(P<0.001), while there was no statistically significant difference between the two groups(P>0.05). At 1 week postoperatively, the LUSE-ACDF group demonstrated significantly greater improvement in VAS scores compared with the conventional ACDF group(2.00±1.06 vs 2.88±1.12, P<0.01), and had a smaller surgical incision(3.46±1.12cm vs 4.25±0.87cm, P<0.01). At 6 months postoperatively, the LUSE-ACDF group demonstrated significant improvements in the minimum sagittal diameter of the spinal canal(14.16±1.98mm vs 10.82±1.86mm, P<0.001) and the anterior column height of the operative segment(34.45±6.08mm vs 29.48±3.86mm, P<0.05) compared with preoperative measurements, while there was no significant difference in the C2-7 Cobb angle compared with preoperative measurements(P>0.05). In the conventional ACDF group, there were no significant changes in these three parameters before or after surgery(P>0.05). At 6 months post-operatively, the improvement in the minimum sagittal diameter of the spinal canal was significantly greater in the LUSE-ACDF group than in the conventional ACDF group(14.16±1.98mm vs 11.92±1.68mm, P<0.05); however, there were no significant differences between the two groups in the measurements of the other radiological parameters at the same time point. Postoperative MRI revealed no significant prevertebral soft tissue edema in either group. Conclusions: LUSE-ACDF can yield favorable clinical results comparable to conventional ACDF in the treatment of single-level CSM, with specific benefits in early postoperative recovery.