Anterior cervical discectomy and fusion combined with posterior percutaneous endoscopic cervical discectomy for the treatment of “pinching” cervical spondylosis
Li Zeyang, Li Jiaqi, Zhang Fei, Sun Yapeng, Guo Lei, Zhang Wei, Wang Xianzheng, Cui Hao, Gao Yuan
Department of Spain Surgery, the Third Hospital of Hebei Medical University, Shijiazhuang 050051, China
Abstract:Objective To investigate the efficacy of anterior cervical discectomy and fusion (ACDF)combined with posterior percutaneous endoscopic cervical discectomy (PPECD) for the treatment of “pinching” cervical spondylotic myelopathy.Methods A retrospective analysis was conducted for 28 patients with “pinching” cervical spondylotic myelopathy who were admitted to the Third Hospital of Hebei Medical University from March 2015 to May 2017 with the complete spinal surgery imaging and follow-up data were included. There were 15 males and 13 females. The age was 33-71 (52.214±8.234) years old. Fifteen patients who received anterior cervical decompression and fusion surgery were enrolled in the ACDF group. And 13 patients who received anterior cervical decompression and fusion combined with posterior percutaneous endoscopic cervical discectomy were enrolled in the combined surgery group. After 1 year of follow-up, the cervical visual analogue score(VAS) , the Japan Orthopaedic Association (JOA) score, the cervical curvature (Cobb angle), ligamentum flavum area, spinal canal sagittal diameter, spinal canal area, spinal cord area, inter-vertebral height and axial symptoms were compared between the two groups.Results There were no statistically significant differences in the baseline data such as gender, age, duration of disease, preoperative clinical manifestations (neck disability index score) and operative segment between the two groups (all P values>0.05). During the one year follow-up period, the JOA score and the VAS score of the two groups were significantly improved (all P values<0.01). Compared with the combined surgery group, there was no significant difference in the Cobb angle of the ACDF group after surgery(10.85 °± 2.79°, 9.33°± 3.48°) (t=-1.255, P>0.05). The differences in the ligamentum flavum area, spinal canal sagittal diameter, spinal canal area and spinal cord area at 1 year after surgery were statistically significant between the two groups (t=9.403, -2.855, -8.007, -2.447, all P values<0.05), and there were significant differences between the two groups before and after surgery (all P values<0.01)。 There was no significant difference between the two groups in the inter-vertebral height at 1 year after surgery (t=-0.534, P>0.05), but there was a significant difference before and after surgery in the two groups(all P values<0.01).When the two groups of patients were followed up for 1 year, it was found that there was no significant difference in the number of postoperative axial symptoms between the two groups (P=0.705).Conclusions The combined surgery is more thorough than the traditional cervical anterior surgery and more conducive to the recovery of spinal cord function.At the same time, it effectively avoids the back of the neck soft tissue damage of the traditional posterior surgery.
李泽阳, 李佳奇, 张飞, 孙亚彭, 郭磊, 张为, 王宪正, 崔浩, 高原. 前路减压联合后路内镜手术在 “钳夹式”颈椎病治疗中的应用[J]. 中华解剖与临床杂志, 2020, 25(3): 297-302.
Li Zeyang, Li Jiaqi, Zhang Fei, Sun Yapeng, Guo Lei, Zhang Wei, Wang Xianzheng, Cui Hao, Gao Yuan. Anterior cervical discectomy and fusion combined with posterior percutaneous endoscopic cervical discectomy for the treatment of “pinching” cervical spondylosis. Chinese Journal of Anatomy and Clinics, 2020, 25(3): 297-302.
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