Comparison of percutaneous full-endoscopic posterior cervical foraminotomy versus anterior cervical disc replacement for single-level cervical spondylotic radiculopathy

English Keywords:Cervical spondylotic radiculopathy  Cervical foraminotomy  Cervical disc replacement  Clinical efficacy

English Abstract:

  【Abstract】　Objectives: To compare the clinical efficacy of percutaneous full-endoscopic posterior cervical foraminotomy(PE-PCF) and anterior cervical disc replacement(ACDR) for the treatment of single-level cervical spondylotic radiculopathy(CSR). Methods: 72 patients with single-level CSR treated in our hospital from January 2020 to December 2022 were retrospectively analyzed. The cohort included 49 males and 23 females, aged 30-70 years(49.2±8.0 years). The postoperative follow-up period ranged from 14 to 32 months(18.8±4.2 months). Patients were divided into a PE-PCF group and an ACDR group based on the surgical procedure. No significant differences were observed between the two groups in age, sex, surgical level, or follow-up duration(P>0.05). Operative time, intraoperative blood loss, and length of hospital stay were compared between the two groups. The degree of neck and upper limb pain was assessed using the visual analogue scale(VAS), and the neck functional was evaluated using the neck disability index(NDI) before surgery, at 3d and 6 months postoperatively, and at the final follow-up. The disc height(DH) of the surgical segment, the surgical segment range of motion(S-ROM), the cervical range of motion(ROM), and the cervical Cobb angle(CA) were measured on radiographs obtained preoperatively, at 3d postoperatively, and at the final follow-up. Results: The operation was successfully completed in both groups. The PE-PCF group had significantly shorter operative time, less intraoperative blood loss, and shorter hospital stay compared to the ACDR group(P<0.05). Both groups showed significant improvements in VAS and NDI scores at 3d and 6 months postoperatively and at the final follow-up compared to preoperative values(P<0.001). At 3d postoperatively, the PE-PCF group had significantly better upper limb VAS and NDI scores than the ACDR group(P<0.05); however, no significant intergroup differences were observed at 6 months or at the final follow-up(P>0.05). No significant differences were found in neck pain VAS scores between the two groups at 3d, 6 months, or the final follow-up(P>0.05). In the PE-PCF group, no significant change in DH was observed 3d postoperatively or at the final follow up compared with the preoperative value(P=0.715). In the ACDR group, DH increased postoperatively and at the final follow-up compared with the preoperative value(P<0.001), and DH was higher at all time points than that in the PE-PCF group(P<0.001). In both groups, S-ROM increased postoperatively and at the final follow-up compared with the preoperative value(P<0.001), and S-ROM was greater in the ACDR group than in the PE-PCF group at all time points(P<0.001). ROM decreased in the PE-PCF group at postoperation and final follow-up compared with preoperation(P=0.043). No significant change in ACDR group(P=0.176). No significant between-group differences at any time point(P＞0.05). In both groups, CA increased postoperatively and at the final follow-up compared with the preoperative value(P<0.05), and the CA in the ACDR group was greater than that in the PE-PCF group at all time points(P<0.001). Conclusions: Both PE-PCF and ACDR are effective treatments for CSR. PE-PCF offers advantages of shorter operative time, less blood loss, faster recovery, and shorter hospital stay, whereas ACDR is more beneficial for restoring index-level disc height, segmental mobility, and cervical physiological lordosis.