Comparison of short-term efficacies between L-unitary soft endoscopic anterior cervical discectomy and fusion(LUSE-ACDF) and anterior cervical discectomy and fusion(ACDF) in the treatment of two-level cervical spondylotic myelopathy

English Keywords:Anterior cervical discectomy and fusion(ACDF)  Two-level cervical spondylotic myelopathy  Flexible spinal endoscopy  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To compare the short-term efficacy of L-unitary soft endoscopic anterior cervical discectomy and fusion(LUSE-ACDF) and anterior cervical discectomy and fusion(ACDF) in the treatment of two-level cervical spondylotic myelopathy(CSM). Methods: A retrospective analysis was conducted on 48 patients with two-level CSM treated in the Fifth Department of Orthopedics at Liaoning Provincial People′s Hospital from January 2024 to March 2025. Among them, 25 patients underwent LUSE-ACDF were included in the LUSE-ACDF group(13 males, 12 females, aged 57.7±10.2 years, affected segments: C3-C5 in 5 cases, C4-C6 in 11 cases, and C5-C7 in 9 cases), and 23 patients received ACDF were included in the ACDF group(13 males, 10 females, aged 59.7±8.4 years, affected segments: C3-C5 in 5 cases, C4-C6 in 10 cases, and C5-C7 in 8 cases). General patient data including age, sex, body mass index(BMI), and so on were comparable between the two groups(P>0.05). Intraoperative variables such as blood loss, operative time, incision length, hospital stay, and surgical complications were recorded and compared. All patients were followed up for 6 to 12 months. Follow-up evaluations were conducted preoperatively, at 1 week, 1 month, and 6 months postoperatively, using the visual analog scale(VAS) score for neck pain, Japanese Orthopaedic Association(JOA) scores, and JOA score improvement rate. Results: Compared with ACDF group, LUSE-ACDF group was significantly less in intraoperative blood loss(41.32±7.33mL vs 60.78±11.62mL, P<0.05), longer in the operative time(110.40±9.22min vs 94.96±8.67min, P<0.05), shorter in the incision length(3.04±0.22cm vs 3.44±0.27cm, P<0.05) and the length of hospital stay(8.68±1.25d vs 9.82±1.03d, P<0.05). In terms of postoperative complications, no relevant complications occurred in the LUSE-ACDF group; In the ACDF group, one patient developed anterior cervical edema and dysphagia, and the symptoms were relieved after treatment with mannitol to reduce edema. Both groups showed significant improvement in neck VAS and JOA scores at 1 week, 1 month, and 6 months postoperatively compared to preoperative values(P<0.05). The LUSE-ACDF group had significantly better neck VAS and JOA scores than the ACDF group at 1 week and 1 month postoperatively(P<0.05). Conclusions: Both LUSE-ACDF and ACDF are effective surgical procedures for the treatment of two-level CSM. Compared to ACDF, LUSE-ACDF offers minimally invasive advantages such as reduced intraoperative bleeding, smaller incisions, and shorter hospital stays, and it promotes early postoperative pain relief and neurological function recovery. Although its long-term efficacy is comparable to that of open surgery, it demonstrates potential value in reducing early postoperative complications(such as dysphagia) and improving short-term quality of life.