Comparison of the efficacy between posterior cervical endoscopic laminoforaminotomy with discectomy and endoscopic anterior cervical discectomy and fusion in the treatment of single-level cervical spondylotic radiculopathy

English Keywords:Spinal endoscopy  Key-hole  Anterior cervical discectomy and fusion  Cervical spondylotic radiculopathy  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To compare the clinical efficacy of posterior cervical endoscopic laminoforaminotomy with discectomy(key-hole) and endoscopic anterior cervical discectomy and fusion(Endo-ACDF) in the treatment of single-level cervical spondylotic radiculopathy(CSR). Methods: A retrospective analysis was conducted on 41 patients with single-level CSR treated at the Department of Orthopedics of our hospital from February 2022 to January 2024. There were 24 males and 17 females, with a mean age of 56.8±13.2years(range, 32-81 years) and a mean follow-up of 13.9±1.0months(range, 12-16 months). Patients were divided into a key-hole group(n=19) and an Endo-ACDF group(n=22) according to the surgical approach. No statistically significant differences were found between the two groups in sex, age, body mass index(BMI), or surgical segment(P>0.05). The operative time, incision length, intraoperative blood loss, postoperative hospital stay, and complications were recorded. Pain and functional outcomes were evaluated preoperatively, at 1 week postoperatively, and at the final follow-up using the visual analogue scale(VAS) for neck and shoulder pain, the Japanese Orthopaedic Association(JOA) score, and the neck disability index(NDI). Clinical efficacy at the final follow-up was assessed according to the modified MacNab criteria. Radiographic evaluation included X-ray, CT, and MRI examinations preoperatively and at the final follow-up. The intervertebral disc height at the affected segment and the cervical physiological curvature(Cobb angle) were measured on lateral radiographs. The foraminal height and foraminal area on the affected side were measured on sagittal CT images, and the spinal canal area was measured on axial MRI images. Results: All surgeries were completed successfully. In the key-hole group, one patient experienced an intraoperative dural injury; postoperatively, the patient was placed in a Trendelenburg position and administered prophylactic antibiotics. No cerebrospinal fluid leak-related complications or secondary infections occurred. In the Endo-ACDF group, one patient developed hoarseness; aerosol inhalation, neurotrophic medications, and other symptomatic treatments were administered. The hoarseness improved at discharge and had resolved completely by the final follow-up. Compared with the Endo-ACDF group, the key-hole group had significantly shorter operative time(79.57±8.1min vs. 88.05±4.82min), less intraoperative blood loss[30.00(25.00, 30.00)mL vs. 65.00(60.00, 70.00)mL], smaller incision length(2.3±0.1cm vs. 4.1±0.3cm), and shorter postoperative hospital stay[5.00(4.00, 5.00)d vs. 6.00(5.00, 7.00)d](P<0.05). At 1 week postoperatively and at the final follow-up, the JOA scores, VAS scores, and NDI were significantly improved in both groups compared with preoperative values(P<0.05), and no significant differences in these parameters were observed between the two groups(P>0.05). At the final follow-up, no significant difference was found between the two groups in the modified MacNab criteria(P>0.05). At the final follow-up, the spinal canal area, foraminal area, and cervical Cobb angle were significantly improved in both groups compared with preoperative measurements(P<0.05). However, at the final follow-up, the key-hole group showed no significant change in foraminal height compared with the preoperative value(P>0.05), while a slight decrease in intervertebral disc height was observed(P<0.05). At the final follow-up, the Endo-ACDF group showed significantly greater intervertebral disc height, spinal canal area, and C2-7 Cobb angle compared with the key-hole group, whereas the key-hole group exhibited a significantly larger foraminal area than the Endo-ACDF group(P<0.05). Conclusions: Both posterior endoscopic key-hole and Endo-ACDF achieve satisfactory outcomes in the treatment of single-level CSR. The key-hole technique offers advantages of shorter operative time, smaller incision, less blood loss, shorter postoperative hospital stay, and more thorough foraminal decompression; Endo-ACDF is more effective in restoring intervertebral disc height and cervical physiological curvature, and it provides more thorough spinal canal decompression.