Comparison of long-term prognosis of percutaneous endoscopic cervical discectomy via posterior key-hole approach(PECD) versus anterior cervical discectomy and fusion(ACDF) in the treatment of single-segment cervical spondylotic radiculopathy

English Keywords:Cervical spondylotic radiculopathy  Percutaneous endoscopic cervical discectomy via posterior key-hole approach  Anterior cervical discectomy and fusion  Propensity score matching

English Abstract:

  【Abstract】 Objectives: To compare the long-term clinical efficacy and prognosis of percutaneous endoscopic cervical discectomy via posterior key-hole approach(PECD) and anterior cervical discectomy and fusion(ACDF) in the treatment of single-segment cervical spondylotic radiculopathy(CSR), so as to provide reference for the selection of clinical surgical schemes. Methods: The clinical data of 324 patients with single-segment CSR who underwent surgical treatment in our hospital from June 2015 to August 2018 were retrospectively analyzed. The patients were divided into a PECD group(72 cases) and an ACDF group(252 cases) according to the surgical method. Propensity score matching(PSM) was used at a 1:2 ratio to balance the confounding variables(age, gender, body mass index, disease duration, smoking history, drinking history, underlying health conditions, surgical segment, preoperative upper limb muscle strength classification, preoperative cervical lortosis angle) between the two groups. After PSM matching, 42 patients in the PECD group and 84 patients in the ACDF group were included in the final analysis. Perioperative indicators(operative time, intraoperative blood loss, incision length, hospital stay) of the two groups were collected. Functional scores[arm visual analog scale(A-VAS) score, neck visual analog scale(N-VAS) score, Japanese Orthopaedic Association(JOA) score, neck disability index(NDI)] and imaging indicators[disc height index(DHI), range of motion(ROM), ratio of grey scale(RVG), sagittal translation(ST)] were recorded before surgery and at 7d, 3 months, 12 months, 24 months after surgery and final follow-up(60-78 months). The occurrence of complications and the modified MacNab efficacy evaluation results at final follow-up were also recorded. Adjacent segment degeneration/disease at final follow-up was evaluated based on clinical symptoms and available radiographic findings. Results: All patients completed follow-up, with an average time of 5.6±0.8 years. The operative time, intraoperative blood loss, incision length and hospital stay in the PECD group were significantly better than those in the ACDF group(P<0.001). The A-VAS, N-VAS, JOA scores and NDI of both groups at each time point after surgery were significantly improved compared with those before surgery(P<0.001), and the improvement degree of each functional score in the PECD group at 7d after surgery was significantly better than that in the ACDF group(P<0.05); There was no significant difference in the above functional scores between the two groups at 12 months, 24 months after surgery and the final follow-up(P>0.05). Imaging results showed that the DHI of the surgical segment in the ACDF group at each time point after surgery was significantly higher than that in the PECD group(P<0.05); The global range of motion(GROM) and adjacent segment ROM of the cervical spine in the PECD group at each time point after surgery were significantly better than those in the ACDF group(P<0.05); At final follow-up, the decrease range of RVG in adjacent segments of the ACDF group was significantly larger than that of the PECD group(P<0.05). The postoperative ST of both groups was <3mm, indicating a good cervical segmental stability. The complication rate was 9.52%(4/42) in the PECD group and 10.71%(9/84) in the ACDF group, with no significant difference between the two groups(P>0.05). At final follow-up, the excellent and good rate of modified MacNab was 92.86%(39/42) in the PECD group, and 89.29%(75/84) in the ACDF group, with no significant difference between the two groups(P>0.05). Conclusions: Both PECD and ACDF can achieve satisfactory long-term clinical efficacy in the treatment of single-segment CSR. PECD has the advantages of less trauma, faster postoperative recovery, less impact on cervical motor function and reducing adjacent segment degeneration.