Comparison of the efficacy of endoscopic and non-endoscopic anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy

English Keywords:Cervical spondylotic radiculopathy  Anterior cervical discectomy and fusion  Endoscope-assisted  Minimally invasive surgery

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacies of endoscope-assisted anterior cervical discectomy and fusion(Endo-ACDF) and traditional open anterior cervical discectomy and fusion(ACDF) in the treatment of cervical spondylotic radiculopathy(CSR). Methods: A retrospective analysis was performed on 67 patients with CSR who underwent surgical treatment in our hospital from January 2022 to June 2024. Among them, 32 patients(18 males and 14 females; age 47.6±8.3 years) received Endo-ACDF(Endo-ACDF group), and 35 patients(20 males and 15 females; age 48.4±8.7 years) received traditional ACDF(ACDF group). Operation time, intraoperative blood loss, postoperative drainage volume, time to ambulation, and postoperative hospital stay were recorded. Preoperatively, at 3d, 12 months postoperatively, and final follow-up, neck and upper limb pain was assessed using the visual analogue scale(VAS) score, and neurological function was evaluated using the Japanese Orthopaedic Association(JOA) score, with the JOA score improvement rate calculated at final follow-up. C2-7 Cobb angle, fused segment Cobb angle, and intervertebral disc height were measured on cervical lateral radiographs preoperatively, at 3d postoperatively, and final follow-up. Interbody fusion was assessed using the Brantigan criteria at 12 months postoperatively and final follow-up. Results: All 67 patients successfully underwent the operation without serious complications such as spinal cord injury, nerve root tear, dural tear, or major vascular injury. The operation time in the Endo-ACDF group was significantly longer than that in the ACDF group(100.2±25.3min vs 65.2±15.3min, P<0.05), while intraoperative blood loss, postoperative drainage volume, time to ambulation, and postoperative hospital stay were significantly lower in the Endo-ACDF group than in the ACDF group(20.6±10.7mL vs 42.6±18.7mL, 10.0±2.7mL vs 18.0±3.5mL, 1.2±0.3d vs 2.5±0.6d, 5.1±0.8d vs 6.8±1.0d, P<0.05). One patient in the Endo-ACDF group developed mild hoarseness, which was resolved after conservative treatment before discharge. One patient in each group experienced transient dysphagia, which was resolved spontaneously without special treatment. The mean follow-up period was 18.5±3.2 months(range, 12-24 months). Compared with preoperative values, JOA scores increased significantly and VAS scores decreased significantly at all postoperative time points in both groups(P<0.05). There were no significant differences in JOA scores and VAS scores between the two groups at the same time points(P>0.05), and no significant difference was found in JOA score improvement rate at final follow-up(P>0.05). C2-7 Cobb angle, fused segment Cobb angle, and intervertebral disc height were significantly improved at postoperative and final follow-up time points compared with preoperative values(P<0.05), with no significant differences between the final follow-up and 3d postoperatively(P>0.05); And there were no significant differences between the two groups at the same time points(P>0.05). At 12 months postoperatively and final follow-up, there was no significant difference in bony fusion rate between the two groups(P>0.05), and all patients achieved bony fusion. Conclusions: Both Endo-ACDF and ACDF can achieve satisfactory clinical efficacy and radiographic outcomes in the treatment of CSR, with comparable results in neurological function improvement, pain relief, cervical curvature restoration, and interbody fusion rate. Compared with ACDF, Endo-ACDF offers the advantages of minimally invasive surgery, including less trauma and faster recovery.