Clinical efficacy of uniaxial endoscopic anterior cervical discectomy and fusion via mini-open approach for cervical spondylotic myelopathy with calcified disc herniation

English Keywords:Cervical spondylotic myelopathy  Calcified disc herniation  Anterior cervical discectomy and fusion  Full-endoscopic spine surgery  Microscope  Minimally invasive spine surgery

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy of uniaxial endoscopic anterior cervical discectomy and fusion(Endo-ACDF) in the treatment of cervical spondylotic myelopathy(CSM) complicated with calcified disc herniation. Methods: A retrospective analysis was conducted on 22 CSM patients with single-level or double-level calcified cervical disc herniation who received treatment at the Spinal Minimally Invasive Surgery Center from May 2022 to January 2025. Among them, 11 patients undergone Endo-ACDF were assigned to the Endo-ACDF group(6 males and 5 females, aged 38-77 years); Another 11 patients received microscopic anterior cervical discectomy and fusion(Micro-ACDF) were included in the Micro-ACDF group(4 males and 7 females, aged 38-69 years). Perioperative indicators(operation time, intraoperative blood loss, hidden blood loss, postoperative hospital stay), radiological parameters(preoperative, 1d postoperative and 1-month postoperative prevertebral soft tissue swelling, differences in intervertebral height, overall cervical lordotic angle and segmental lordotic angle of the operative level, as well as changes in spinal canal area before and after surgery), and clinical outcome indicators[visual analogue scale(VAS) score, Japanese Orthopaedic Association(JOA) score and neck disability index(NDI)] before operation, at 1d, 3 months, 6 months postoperatively and the final follow-up, along with Bridwell grading at 6 months after surgery were compared between the two groups. Results: There were no significant differences in baseline data including age, gender, calcification status and operative segments between the two groups(P>0.05). The Endo-ACDF group presented significantly less intraoperative blood loss(16.36±6.74mL vs 24.55±5.22mL, P=0.005) and hidden blood loss(131.32±64.17mL vs 203.54±81.26mL, P=0.013) than the Micro group. No significant differences were observed in operation time and postoperative hospital stay between the two groups(P>0.05). The changes of postoperative spinal canal area in the Endo-ACDF group was notably higher than that in the Micro-ACDF group(53.21±24.90mm2 vs 34.82±15.87mm2, P=0.048). No intergroup differences were found in prevertebral soft tissue swelling, changes of intervertebral height, overall cervical lordosis and segmental lordosis at each time point before and after surgery(P>0.05). In terms of clinical outcomes, the two groups showed comparable VAS, JOA and NDI scores as well as their improvement degrees at all follow-up time points, with no significant difference in Bridwell grading at 6 months postoperatively(P>0.05). Conclusions: Both Endo-ACDF and Micro-ACDF can achieve satisfactory clinical outcomes and fusion effects for CSM combined with calcified disc herniation. Endo-ACDF has unique advantages in reducing intraoperative and postoperative hidden blood loss and improving the efficiency of spinal canal decompression.