Clinical efficacy of large-channel endoscopic posterior cervical spinal canal decompression in treating multilevel cervical spondylotic myelopathy and effects on cervical sagittal morphology

English Keywords:Cervical spondylotic myelopathy  Multilevel  Endoscopic posterior cervical canal decompression  Cervical sagittal plane morphology

English Abstract:

  【Abstract】　Objectives: To investigate the efficacy of large-channel endoscopic posterior cervical canal decompression(Endo-PCCD) for multilevel cervical spondylotic myelopathy(MCSM) and its impact on cervical sagittal morphology. Methods: A retrospective analysis was conducted on 34 patients with MCSM who underwent large-channel Endo-PCCD in the Department of Orthopedics Surgery from June 2022 to June 2024. There were 19 males and 15 females, aged 36-78 years(62.7±9.6 years). 13 patients had two-level involvement(C3-C5: 7 cases, C5-C7: 6 cases), 20 patients had three-level involvement(C3-C6: 19 cases, C4-C7: 1 case), and 1 patient had four-level involvement(C3-C7). The operative time, postoperative drainage volume, and complications were recorded. The Japanese Orthopaedic Association(JOA) score, visual analogue scale(VAS) score, and neck disability index(NDI) were collected, and C2-7 Cobb angle, T1 slope(T1S), and C2-7 sagittal vertical axis(SVA) were measured on X-ray images preoperatively, at 3 months and 6 months postoperatively. Results: All 34 patients successfully underwent large-channel Endo-PCCD. The operative time ranged from 112 to 176min(135.2±38.5min). The 24h postoperative drainage volume was less than 50mL in all patients. Two patients experienced significant pain at the surgical incision area, which was relieved after adding 300mg of gabapentin. One patient developed C5 nerve root palsy with right shoulder abduction weakness postoperatively, which recovered at 4 months after surgery. At preoperation, 3 months and 6 months postoperatively, the JOA scores were 9.35±1.31, 12.47±1.18, and 14.58±0.92, respectively; The NDI values were (34.41±5.34)%, (23.07±2.94)%, and (15.91±3.32)%, respectively; The VAS scores were 5.32±1.02, 2.10±0.96, and 1.88±0.95, respectively; The C2-7 Cobb angles were 10.37°±3.48°, 12.64°±3.28°, and 14.59°±3.57°, respectively; The T1S values were 29.24°±7.72°, 24.82°±7.26°, and 23.43°±8.51°, respectively; And the C2-7 SVA values were 22.12±6.24mm, 18.34±5.72mm, and 17.28±5.44mm, respectively. Compared with preoperative values, the JOA scores and C2-7 Cobb angles at 3 and 6 months postoperatively were significantly increased(P<0.05), while the VAS scores, NDI, T1S, and C2-7 SVA were significantly decreased(P<0.05). Compared with the 3-month postoperative values, there were significant differences in JOA score, NDI, and C2-7 Cobb angle at 6 months postoperatively(P<0.05). Conclusions: Endo-PCCD not only demonstrates significant clinical efficacy in treating MCSM, but also results in a certain degree of improvement in postoperative cervical sagittal morphology.