Efficacy analysis of posterior percutaneous endoscopic cervical discectomy in treating adjacent segment disease after cervical fusion

English Keywords:Spinal endoscopy  Cervical fusion  Adjacent segment disease  Cervical spondylotic radiculopathy  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy of posterior percutaneous endoscopic cervical discectomy(PPECD) in treating adjacent segment disease(ASD) with nerve root compression symptoms after anterior cervical fusion surgery. Methods: This study retrospectively analyzed 12 patients with ASD after anterior cervical fusion surgery admitted to our Spinal Surgery Department from June 2018 to June 2023. There were 7 male cases and 5 female cases, with an average age of 58.2±18.1 years. The patients inclusion criteria were the occurrence of simple nerve root compression symptoms and receiving PPECD treatment. The general data, operative time, intraoperative blood loss, hospital stay, and complications were recorded. At preoperation, 1d postoperation, 3 months postoperation and at final follow-up. Pain was assessed using the visual analog scale(VAS), neurological function was evaluated with the Japanese Orthopaedic Association(JOA) score, and functional status was measured by the neck disability index(NDI). Clinical outcomes were graded according to Odom′s criteria and JOA improvement rates. Radiographic evaluation included measurement of segmental range of motion(ROM) from dynamic cervical radiographs and disc space height from lateral radiographs before operation and at final follow-up. Results: All patients successfully underwent PPECD without conversion to open surgery. The mean operative time was 85.8±15.6min, mean intraoperative blood loss was 26.2±8.5mL, and mean hospital stay was 5.5±1.0d. The follow-up period ranged from 24 to 68 months(mean, 37.1±15.2 months). At postoperative 1d, 3 months, and final follow-up, significant improvements were observed in neck and upper limb VAS scores, NDI, and JOA scores compared to preoperative values(P<0.05). Furthermore, scores at 3 months and final follow-up showed further improvement compared to those at 1d postoperatively(P<0.05). At the final follow-up, the excellent-to-good rate according to Odom′s criteria was 91.67%, and the mean JOA improvement rate was 72.5%. No statistically significant differences were found in segmental ROM or disc space height between preoperative and final follow-up measurements(P>0.05). No serious intraoperative or postoperative complications, such as spinal cord or nerve injury, vertebral artery injury, or surgical site infection, occurred. Conclusions: PPECD is a safe and effective minimally invasive surgical technique for the treatment of ASD presenting with nerve root compression after cervical fusion. It effectively alleviates nerve compression symptoms, improves patient function, and has minimal impact on the stability of the surgical segment, yielding satisfactory short-to-midterm outcomes.