Clinical study of posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression in the treatment of single-segment cervical spondylotic myelopathy
Chen Song1, Zhang Wei2, Suo Shiqi1, Wang Yunxia2, Sun Yapeng2, Fu Zhian1
1Department of Spine Surgery, Affiliated Hospital of Hebei University of Engineering, Handan 056002, China; 2Department of Spinal Surgery, the Third Hospital, Hebei Medical University, Shijiazhuang 050051, China
Abstract：Objective To investigate the clinical effect of posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression in the treatment of single-segment cervical spondylotic myelopathy (CSM).Methods The clinical data of 17 patients with single segmental CSM treated with posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression at the Department of Spinal Surgery in the Third Hospital of Hebei Medical University and the Affiliated Hospital of Hebei Engineering University from February 2017 to March 2019 were analyzed retrospectively. A total of 11 males and nine females aged 42-81 years were included in this study. The Cobb angle and the range of motion (ROM) of the operative segment were compared before and after the operation. Neck disability index (NDI) and Japanese Orthopedic Association (JOA) scores were used to evaluate neurological function. The modified MacNab criteria were used to evaluate the clinical efficacy during the final follow up. The operation time, blood loss, hospitalization time, and related complications were recorded.Results The operation was performed successfully in 17 patients. The mean operation time, intraoperative blood loss, and hospitalization time were (71.1±10.1) min, (76.9±16.4) mL, and (6.3±1.7) days, respectively. The follow-up time was 12-18 (13.7±1.9) months. One patient in the group had dural laceration, while the other patients had no complications, such as spinal cord injury, important vascular injury, cerebrospinal fluid leakage, and wound infection. The Cobb angle of the cervical vertebra at 1 month, 3 months, and 12 months after the operation (21.6°±4.2°, 24.2°±4.1°, and 22.8°±3.8°, respectively) increased compared with that before the operation (17.8°±3.9°), with statistically significant difference (all P values<0.05). No significant difference was found between the ROM of the operation segment at each time point after and before the operation (all P values > 0.05). Significant differences were observed between the NDI at each time point after (16.8%±2.1%, 14.3%±1.8%, and 12.3%±1.9%) and before (32.4%±2.4%) the operation (all P values<0.05). Significant differences were also found between different time points in the group (all P values<0.05). In addition, significant differences were observed between the JOA scores at each time point after (12.8±2.4, 14.4±1.8, and 15.2±1.9, respectively) and before (8.6±2.2) the operation (all P values<0.05) and between 12 months and 1 month after the operation (P＜0.05). In accordance with the modified MacNab criteria, nine patients scored excellent, six scored good, and two scored fair, and the overall excellent and good rate was 15/17 at the final follow up.Conclusions Posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression is a safe and effective method in the treatment of single-segment CSM. It has the advantages of less trauma, rapid postoperative recovery, and good clinical efficacy. However, the surgical indications should be strictly controlled.
陈松, 张为, 索世琪, 王云霞, 孙亚澎, 付治安. 颈后路经皮大通道全内镜椎板减压术治疗单节段脊髓型颈椎病的临床效果观察[J]. 中华解剖与临床杂志, 2021, 26(1): 61-67.
Chen Song, Zhang Wei, Suo Shiqi, Wang Yunxia, Sun Yapeng, Fu Zhian. Clinical study of posterior percutaneous large channel full-endoscopic cervical laminectomy and decompression in the treatment of single-segment cervical spondylotic myelopathy. Chinese Journal of Anatomy and Clinics, 2021, 26(1): 61-67.
Spanos SL, Siasios ID, Dimopoulos VG, et al. Correlation of clinical and radiological outcome after anterior cervical discectomy and fusion with a polyetheretherketone cage[J]. J Clin Med Res, 2018, 10(3): 268-276. DOI:10.14740/jocmr3326w.
[2]
Ko SB, Park JB, Song KJ, et al. Esophageal perforation after anterior cervical spine surgery[J]. Asian Spine J, 2019, 13(6): 976-983. DOI:10.31616/asj.2018.0316.
[3]
Yang Z, Zhao Y, Luo J. Incidence of dysphagia of zero-profile spacer versus cage-plate after anterior cervical discectomy and fusion: a meta-analysis[J]. Medicine (Baltimore), 2019, 98(25): e15767. DOI:10.1097/MD.0000000000015767.
[4]
Li Z, Li G, Chen C, et al. Risk factors for dysphagia after anterior cervical spine surgery[J]. Orthopedics, 2018, 41(1): e110-e116. DOI:10.3928/01477447-20171213-04.
[5]
Miller J, Sasso R, Anderson P, et al. Adjacent level degeneration: bryan total disc arthroplasty versus anterior cervical discectomy and fusion[J]. Clin Spine Surg, 2018, 31(2): E98-E101. DOI:10.1097/BSD.0000000000000598.
[6]
Donk R D, Verhagen W, Hosman A, et al. Symptomatic adjacent segment disease after anterior cervical discectomy for single-level degenerative disk disease[J]. Clin Spine Surg, 2018, 31(1): E50-E54. DOI:10.1097/BSD.0000000000000551.
巩腾, 苏学涛, 夏群, 等. 颈椎管单开门扩大成形术后轴性痛并发症原因分析[J]. 中国骨伤, 2018, 31(1): 23-29. DOI:10.3969/j.issn.1003-0034.2018.01.005.Gong T, Su XT, Xia Q, et al. Analysis of reason for postoperative axial pain caused by unilaterally open-door cervical laminoplasty[J]. China J Orthop Trauma, 2018, 31(1): 23-29. DOI:10.3969/j.issn.1003-0034.2018.01.005.
[9]
江泽华, 张学利. 颈后路手术治疗脊髓型颈椎病的临床研究进展[J]. 齐齐哈尔医学院学报, 2017, 38(19): 2312-2315. DOI:10.3969/j.issn.1002-1256.2017.19.038.Jiang ZH, Zhang XL. Progress in clinical research on cervical posterior surgical treatment of cervical spondylotic myelopathy[J]. Journal of Qiqihar University of Medicine, 2017, 38(19): 2312-2315. DOI:10.3969/j.issn.1002-1256.2017.19.038.
[10]
Vernon H, Mior S. The neck disability index: a study of reliability and validity[J]. J Manipulative Physiol Ther, 1991, 14(7): 409-415.
[11]
Hukuda S, Mochizuki T, Ogata M, et al. Operations for cervical spondylotic myelopathy. A comparison of the results of anterior and posterior procedures[J]. J Bone Joint Surg Br, 1985, 67(4): 609-615.
[12]
Sevastikoglou JA, Bergquist E. Evaluation of the reliability of radiological methods for registration of scoliosis[J]. Acta Orthop Scand, 1969, 40(5): 608-613. DOI:10.3109/17453676908989526.
[13]
陈博来, 李永津, 林涌鹏, 等. 经皮全内镜下颈后路椎间盘切除术治疗颈椎间盘突出症临床分析[J]. 中华外科杂志, 2017, 55(12): 923-927. DOI:10.3760/cma.j.issn.0529-5815.2017.12.009.Chen BL, Li YJ, Lin YP, et al. Clinical outcomes of cervical disc herniation treated by posterior percutaneous endoscopic cervical discectomy[J]. Chin J Surg, 2017, 55(12): 923-927. DOI:10.3760/cma.j.issn.0529-5815.2017.12.009.
[14]
Zhang Y, Pan Z, Yu Y, et al. The modified transforaminal endoscopic technique in treating intracanalicular combining foraminal and/or extraforaminal lumbar disc herniations[J]. Quant Imaging Med Surg, 2018, 8(9): 936-945. DOI:10.21037/qims.2018.10.02.
[15]
Lin Y, Rao S, Li Y, et al. Posterior percutaneous full-endoscopic cervical laminectomy and decompression for cervical stenosis with myelopathy: a technical note[J]. World Neurosurg, 2019, 24: 350-357.DOI:10.1016/j.wneu.2018.12.180.
[16]
Wan Q, Zhang D, Li S, et al. Posterior percutaneous full-endoscopic cervical discectomy under local anesthesia for cervical radiculopathy due to soft-disc herniation: a preliminary clinical study[J]. J Neurosurg Spine, 2018, 29(4): 351-357. DOI:10.3171/2018.1.SPINE17795.
[17]
Song Z, Zhang Z, Hao J, et al. Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review[J]. Int Orthop, 2016, 40(6): 1335-1343. DOI:10.1007/s00264-016-3193-4.
[18]
Shen J. Fully endoscopic bilateral cervical laminotomy with unilateral approach for cervical spinal stenosis and myelopathy: a case series[J]. J Spine, 2018, S7: 009. DOI:10.4172/2165-7939.S7-009.
[19]
Wen H, Wang X, Liao W, et al. Effective range of percutaneous posterior full-endoscopic paramedian cervical disc herniation discectomy and indications for patient selection[J]. Biomed Res Int, 2017, 2017: 3610385. DOI:10.1155/2017/3610385.
[20]
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 outcomes of posterior percutaneous endoscopic cervical discectomy for single level cervical spondylotic radiculopathy[J]. Chin J Orthop, 2018, 38(16): 971-980. DOI:10.3760/cma.j.issn.0253-2352.2018.16.002.
[21]
Kim CH, Park TH, Chung CK, et al. Changes in cervical motion after cervical spinal motion preservation surgery[J]. Acta Neurochir (Wien), 2018, 160(2): 397-404. DOI:10.1007/s00701-017-3375-x.
[22]
Joh JY, Choi G, Kong BJ, et al. Comparative study of neck pain in relation to increase of cervical epidural pressure during percutaneous endoscopic lumbar discectomy[J]. Spine (Phila Pa 1976), 2009, 34(19): 2033-2038. DOI:10.1097/BRS.0b013e3181b20250.
[23]
Yang JS, Chu L, Chen L, et al. Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation? A comparative cohort study[J]. Spine (Phila Pa 1976), 2014, 39(21): 1743-1750. DOI:10.1097/BRS.0000000000000508.
[24]
徐宝山, 马信龙, 胡永成. 颈椎和胸椎经皮内镜手术的并发症及预防措施[J]. 中华骨科杂志, 2018, 38(16): 1003-1008. DOI:10.3760/cma.j.issn.0253-2352.2018.16.006.Xu BS, Ma XL, Hu YC. Complications and preventive measures of percutaneous endoscopic surgery for cervical and thoracic vertebrae[J]. Chin J Orthop, 2018, 38(16): 1003-1008. DOI:10.3760/cma.j.issn.0253-2352.2018.16.006.
2021, Vol. 26 
