Clinical efficacy of unilateral biportal endoscopic posterior spinal canal decompression and discectomy for cervical spondylotic myelopathy

English Keywords:Unilateral biportal endoscopy  Cervical spondylotic myelopathy  Minimally invasive surgery  Clinical efficacy

English Abstract:

  【Abstract】 Objectives: To investigate the clinical efficacy and safety of unilateral biportal endoscopy(UBE) technique via the posterior approach in the treatment of cervical spondylotic myelopathy(CSM). Methods: A retrospective analysis was conducted on the clinical data of 24 CSM patients who underwent cervical spinal canal decompression and discectomy via UBE surgery in the Department of Spine Surgery, Wuxi Ninth People′s Hospital from August 2021 to June 2023. There were 9 males and 15 females. Affected segments: C3/4 in 2 cases, C4/5 in 5 cases, C5/6 in 14 cases, and C6/7 in 7 cases. There were 20 cases of single-segment and 4 cases of double-segment involvement. Operation time, fluoroscopy frequency, length of hospital stay, complications, and imaging results were recorded. The patients were followed up for 20-24 months. The Japanese Orthopaedic Association(JOA) score, visual analogue scale(VAS) for pain, and neck disability index(NDI) were used to assess neurological function and pain levels before operation, at postoperative 3 months and final follow-up, meanwhile, imaging examinations were performed. Results: All 24 patients successfully underwent UBE surgery. At 3 months postoperatively and final follow-up, the JOA score was 12(11.5，12) and 15(15, 16), which was statistically different from the preoperative score of 6.39±0.97(P<0.05); The VAS score was 2(1, 2) and 0(0, 1) respectively, statistically different from the preoperative score of 3(3, 4)(P<0.05); The NDI was (20.17±3.58)% and (4.09±1.82)% respectively, statistically different from the preoperative index of 46%(40%, 50%)(P<0.05). Postoperative imaging showed good cervical curvature and significant relief of spinal cord compression, with no cervical instability observed. Postoperative complications included one case of dural tear, which was not directly repaired but covered with gelatin sponge; no obvious cerebrospinal fluid leakage was observed. One patient showed no significant improvement in symptoms postoperatively and opted for open surgery after 3 months of symptomatic treatment. Conclusions: The UBE technique -assisted posterior spinal canal decompression and discectomy for treating CSM can effectively relieve spinal cord compression and alleviate pain, with advantages of being minimally invasive and promoting rapid recovery.