目的:颈椎前路椎间盘切除融合术(ACDF)是治疗颈椎管狭窄症(CSS)的标准方法,但邻近节段退变等并发症可严重影响远期疗效。目前,后路内镜手术已越来越多地应用于CSS的临床治疗中。这项研究的目的是比较接受全内镜椎板切开术或ACDF的单节段CSS患者的临床结果。
方法:回顾性分析2018年6月至2020年8月138例符合纳入标准的CSS患者,分为内镜组和ACDF组。使用倾向评分匹配(PSM)方法来调整组间的不平衡混杂变量。然后,记录围手术期数据并比较临床结局,包括功能评分和成像数据。功能评分包括视觉模拟量表(A-VAS)和颈部疼痛(N-VAS),日本骨科协会评分(JOA),颈部残疾指数(NDI)和成像数据包括光盘高度指数(DHI),颈椎活动范围(ROM),和灰度比(RVG)。
结果:PSM后,84名患者被纳入研究,随访24-30个月。内镜组在手术时间上明显优于ACDF组,术中失血,切口长度,住院时间(P<0.001)。术后N-VAS,A-VAS,JOA,与术前相比,两组患者的NDI和NDI均有显著改善(P<0.001),术后第7天内镜组有较好的改善(P<0.05)。术后12个月及末次随访时,ACDF组邻近节段的ROM变化明显较大(P<0.05)。相邻段的RVG呈下降趋势,末次随访时ACDF组下降更明显(P<0.05)。根据修改后的MacNab标准,内镜组和ACDF组的优良率分别为90.48%和88.10%,分别,差异无统计学意义(P>0.05)。
结论:完全内镜下椎板切开减压术被证明是治疗单节段CSS的传统ACDF的有效替代技术,具有创伤小的优点,更快的恢复,对颈椎运动学和邻近节段变性的影响较小。
OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) is the standard procedure for the treatment of cervical spinal stenosis (CSS), but complications such as adjacent segment degeneration can seriously affect the long-term efficacy. Currently, posterior endoscopic surgery has been increasingly used in the clinical treatment of CSS. The aim of this
study was to compare the clinical outcomes of single-segment CSS patients who underwent full endoscopic laminotomy
decompression or ACDF.
METHODS: 138 CSS patients who met the inclusion criteria from June 2018 to August 2020 were retrospectively analyzed and divided into endoscopic and ACDF groups. The propensity score matching (PSM) method was used to adjust the imbalanced confounding variables between the groups. Then, perioperative data were recorded and clinical outcomes were compared, including functional scores and imaging data. Functional scores included Visual Analog Scale of Arms (A-VAS) and Neck pain (N-VAS), Japanese Orthopedic Association score (JOA), Neck Disability Index (NDI), and imaging data included Disc Height Index (DHI), Cervical range of motion (ROM), and Ratio of grey scale (RVG).
RESULTS: After PSM, 84 patients were included in the
study and followed for 24-30 months. The endoscopic group was significantly superior to the ACDF group in terms of operative time, intraoperative blood loss, incision length, and hospital stay (P < 0.001). Postoperative N-VAS, A-VAS, JOA, and NDI were significantly improved in both groups compared with the preoperative period (P < 0.001), and the endoscopic group showed better improvement at 7 days postoperatively (P < 0.05). The ROM changes of adjacent segments were significantly larger in the ACDF group at 12 months postoperatively and at the last follow-up (P < 0.05). The RVG of adjacent segments showed a decreasing trend, and the decrease was more marked in the ACDF group at last follow-up (P < 0.05). According to the modified MacNab criteria, the excellent and good rates in the endoscopic group and ACDF group were 90.48% and 88.10%, respectively, with no statistically significant difference (P > 0.05).
CONCLUSIONS: Full endoscopic laminotomy
decompression is demonstrated to be an efficacious alternative technique to traditional ACDF for the treatment of single-segment CSS, with the advantages of less trauma, faster recovery, and less impact on cervical spine kinematics and adjacent segmental degeneration.