Clinical application of key-hole lateral mass decompression and discectomy under total spinal endoscopy in cervical spondylotic radiculopathy
Chen Tao1, Huang Sen2, Zhang Cheng2, Ma Cao2, Wang Zhenfei2, Dai Kerong3, Liu Guangwang1,2
1Graduate School of Bengbu Medical College, Bengbu 233030, China; 2Department of Orthopedic, Xuzhou Central Hospital Affiliated to Medical School of Southeast University, Xuzhou 221009, China; 3Department of Orthopedic, Ninth People's Hospital Affiliated to Medical College of Shanghai Jiao Tong University, Shanghai 200240, China
Abstract：Objective This study aimed to explore the clinical efficacy of minimally invasive keyhole lateral mass decompression and discectomy under total spinal endoscopy in the treatment of single-level cervical spondylotic radiculopathy.Methods The clinical data of 40 patients (23 males, 17 females, age range of 32-76 years) with single-level cervical spondylotic radiculopathy in Xuzhou Central Hospital from March 2016 to December 2018 were retrospectively reviewed. In the open group, 20 cases underwent anterior cervical discectomy and fusion(ACDF). In the endoscopy group, 20 cases underwent minimally invasive keyhole lateral mass decompression and discectomy under posterior total spinal endoscopy with local anesthesia. The baseline data of patients, including operation time, bleeding, incision length, hospitalization time, hospitalization cost, and postoperative complications in the two groups were compared. The neck and arm visual analog scale (VAS) and the neck disability index (NDI) of patients in the two groups were compared before the operation; 1 month, 3 months, 6 months, and 1 year after the operation; and on the last follow up. Clinical efficacy was evaluated using the Odom’s grading method during the last follow up.Results No statistically significant difference was found in the baseline data between the two groups (all P values＞0.05). The endoscopy group had shorter operation time, less bleeding, smaller incision, shorter hospitalization time, and lower hospitalization cost than the open group, and the differences were statistically significant (t=3.451, 15.844, 49.438, 6.772, 28.311, all P values<0.01). All patients were followed up for 12-24 months; one case of postoperative complications occurred in the open group and two cases in the endoscopy group. The VAS scores in the open and endoscopy groups were (2.90±0.42) and (2.11±0.29) points at 1 month before the operation, respectively, and the NDI scores were (21.75±3.85) and (17.60±2.04) points, respectively. The difference was statistically significant (t=6.966, 4.260, all P values<0.01). However, no statistically significant difference was found in the VAS and NDI scores before the operation; 3 months, 6 months, and 1 year after the operation; and on the last follow up ( all P values＞0.01). Clinical efficacy was evaluated in accordance with the Odom’s grading method during the last follow up. In the endoscopy group, 14 cases had an excellent rate, while four demonstrated a good rate. In the open group, 15 cases had an excellent rate and three exhibited a good rate. No statistically significant difference was observed in the excellent and good rates between the two groups (Z=-0.311, P<0.05).Conclusions Both types of operation obtained satisfactory clinical efficacy in the treatment of single-level cervical spondylotic radiculopathy. However, minimally invasive keyhole lateral mass decompression and discectomy under posterior total spinal endoscopy with local anesthesia demonstrated the advantages of lessened trauma, quickened recovery, lessened cost, and high security, hence worthy of further promotion and application in clinics.
陈涛, 黄森,,张成, 马超, 王振飞, 戴尅戎, 刘光旺. 后路全脊柱内镜下Key-hole侧块减压髓核摘除术治疗单节段神经根型颈椎病的临床应用[J]. 中华解剖与临床杂志, 2020, 25(5): 484-490.
Chen Tao, Huang Sen, Zhang Cheng, Ma Cao, Wang Zhenfei, Dai Kerong, Liu Guangwang. Clinical application of key-hole lateral mass decompression and discectomy under total spinal endoscopy in cervical spondylotic radiculopathy. Chinese Journal of Anatomy and Clinics, 2020, 25(5): 484-490.
Passias PG, Hasan S, Radcliff K, et al. Arm pain versus neck pain: a novel ratio as a predictor of post-operative clinical outcomes in cervical radiculopathy patients[J]. Int J Spine Surg, 2018, 12(5): 629-637. DOI:10.14444/5078.
[2]
Song KJ, Choi BW, Ham DH, et al. Prognosis of hardware-related problems in anterior cervical discectomy and fusion with cage and plate constructs[J]. World Neurosurg, 2020, 134: e249-e255. DOI:10.1016/j.wneu.2019.10.042.
[3]
Kim CH, Shin KH, Chung CK, et al. Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical diskectomy[J]. Global Spine J, 2015, 5(1): 31-38. DOI:10.1055/s-0034-1395423.
[4]
Rieger B, Sitoci-Ficici KH, Reinshagen C, et al. Endoscopic and microscopic segmental decompression via translaminar crossover spinal approach in elderly patients[J]. World Neurosurg, 2019, 125: e361-e371. DOI:10.1016/j.wneu.2019.01.078
[5]
马俊, 叶晓健, 席焱海, 等. 后路经皮内镜椎间盘切除术治疗单节段神经根型颈椎病的临床疗效[J]. 中华骨科杂志, 2018, 38(16): 971-980. DOI:10.3760/cma.j.issn.0253-2352.2018.16.002.Ma J, Ye XJ, Xi YH, et al. Clinical efficacy of posterior percutaneous endoscopic discectomy for cervical spondylotic radiculopathy[J]. Chin J Orthop, 2018, 38(16): 971-980. DOI:10.3760/cma.j.issn.0253-2352.2018.16.002.
[6]
张锋, 张文志, 段丽群, 等. 通道显微镜下颈后路椎间孔扩大成形术治疗单节段神经根型颈椎病的临床疗效[J]. 中华解剖与临床杂志, 2018, 23(3): 209-213. DOI:10.3760/cma.j.issn.2095-7041.2018.03.007.Zhang F, Zhang WZ, Duan LQ, et al. Clinical outcomes of minimally invasive posterior cervical foraminotomy for single segment cervical spondylotic radiculopathy[J]. Chin J Anat Clin, 2018, 23(3): 209-213. DOI:10.3760/cma.j.issn.2095-7041.2018.03.007.
[7]
Nanda A, Sharma M, Sonig A, et al. Surgical complications of anterior cervical diskectomy and fusion for cervical degenerative disk disease: a single surgeon's experience of 1576 patients[J]. World Neurosurg, 2014, 82(6): 1380-1387. DOI:10.1016/j.wneu.2013.09.022.
[8]
Badve SA, Nunley PD, Kurra S, et al. Review of long-term outcomes of disc arthroplasty for symptomatic single level cervical degenerative disc disease[J]. Expert Rev Med Devices, 2018, 15(3): 205-217. DOI:10.1080/17434440.2018.1433533.
[9]
Kong W, Xin Z, Du Q, et al. Anterior percutaneous full-endoscopic transcorporeal decompression of the spinal cord for single-segment cervical spondylotic myelopathy: The technical interpretation and 2 years of clinical follow-up[J]. J Orthop Surg Res, 2019, 14(1): 461. DOI:10.1186/s13018-019-1474-5.
[10]
吴占勇, 吴华荣, 王会旺, 等. 颈后路扩张通道下钥匙孔减压术治疗神经根型颈椎病[J]. 中国矫形外科杂志, 2016, 24(11): 981-985. DOI:10.3977/j.issn.1005-8478.2016.11.05.Wu ZY, Wu HR, Wang HW, et al. Posterior cervical “key hole” laminectomy decompression for cervical radiculopathy using a new-designed expansive channel[J]. Chinese Journal of Plastic Surgery, 2016, 24(11): 981-985. DOI:10.3977/j.issn.1005-8478.2016.11.05.
[11]
Bayoumi AB, Berk S, Efe IE, et al. Posterior cervical keyhole laminoforaminotomy: a cadaveric comparative study to evaluate limits of bony resection[J]. Oper Neurosurg (Hagerstown), 2019, 16(5): 607-613. DOI:10.1093/ons/opy230.
[12]
张迎春, 陈太声, 朱华, 等. 经皮椎间孔镜后路治疗神经根型颈椎病早期疗效观察[J]. 中国骨伤, 2018, 31(4): 306-310. DOI:10.3969/j.issn.1003-0034.2018.04.003.Zhang YC, Chen TS, Zhu H, et al. Observation of early clinical effect of percutaneous transforaminal endoscopic technology in treating cervical spondylotic radiculopathy[J]. China Journal of Orthopaedics and Traumatology, 2018, 31(4): 306-310. DOI:10.3969/j.issn.1003-0034.2018.04.003.
[13]
Xu S, Liang Y, Yu G, et al. Exploration on sagittal alignment and clinical outcomes after consecutive three-level hybrid surgery and anterior cervical discectomy and fusion: a minimum of a 5-year follow-up[J]. J Orthop Surg Res, 2020, 15(1): 79. DOI:10.1186/s13018-020-01589-7.
[14]
Okazaki T, Nakagawa H, Mure H, et al. Microdiscectomy and foraminotomy in cervical spondylotic myelopathy and radiculopathy[J]. Neurol Med Chir (Tokyo), 2018, 58(11): 468-476. DOI:10.2176/nmc.oa.2018-0077.
[15]
Wewel JT, Brahimaj BC, Kasliwal MK, et al. Perioperative complications with multilevel anterior and posterior cervical decompression and fusion[J]. J Neurosurg Spine, 2020, 32(1): 9-14. DOI:10.3171/2019.6.SPINE198.
[16]
Tomé-Bermejo F, Morales-Valencia JA, Moreno-Pérez J, et al. Degenerative cervical disc disease: long-term changes in sagittal alignment and their clinical implications after cervical interbody fusion cage subsidence: a prospective study with standalone lordotic tantalum cages[J]. Clin Spine Surg, 2017, 30(5): E648-E655. DOI:10.1097/BSD.0000000000000293.
[17]
Ren J, Li R, Zhu K, et al. Biomechanical comparison of percutaneous posterior endoscopic cervical discectomy and anterior cervical decompression and fusion on the treatment of cervical spondylotic radiculopathy[J]. J Orthop Surg Res, 2019, 14(1): 71. DOI:10.1186/s13018-019-1113-1.
[18]
Minamide A, Yoshida M, Simpson AK, et al. Microendoscopic laminotomy versus conventional laminoplasty for cervical spondylotic myelopathy: 5-year follow-up study[J]. J Neurosurg Spine, 2017, 27(4): 403-409. DOI:10.3171/2017.2.SPINE16939.
[19]
Quillo-Olvera J, Lin GX, Kim JS. Percutaneous endoscopic cervical discectomy: a technical review[J]. Ann Transl Med, 2018, 6(6): 100. DOI:10.21037/atm.2018.02.09.
[20]
Li C, Tang X, Chen S, et al. Clinical application of large channel endoscopic decompression in posterior cervical spine disorders[J]. BMC Musculoskelet Disord, 2019, 20(1): 548. DOI:10.1186/s12891-019-2920-6.
2020, Vol. 25 
