大量研究证实了颈前路椎间盘切除融合术(ACDF)治疗脊髓型颈椎病的显著临床疗效。实现脊髓直接减压,有效缓解压迫症状。同时,通过分散椎间隙,ACDF有助于恢复颈椎的生理曲率。然而,在手术过程中,一些紧迫的问题仍有待解决。手术视野的深度和照明条件通常限制了对脊髓和周围精细结构的清晰识别,加上初级外科医生和助手之间有限的操作空间和潜在的干扰,所有这些都可能增加手术风险3,4为了克服这些挑战,三维(3D)显微镜在颈椎前路手术中的应用已被证明是一种有效的解决方案。在视频1中,我们演示了3D显微镜下完整的2阶段ACDF操作,初级外科医生和助手通过监视器和外部屏幕观察手术区域,确保舒适的姿势和良好的协调。在我们的回顾性研究中,我们在3D显微镜辅助下分析了16例ACDF病例(包括脊髓型颈椎病伴椎间盘突出和脊柱不稳定的病例)。根据正态检验的结果,我们使用均值(SD)来描述数据。平均(SD)减压时间为37.06(13.30)分钟,总手术时间为114.56(18.11)分钟,失血量为68.13(21.36)mL,没有手术相关的并发症.在6个月的随访中,日本骨科协会的评分有了显著提高,颈部残疾指数评分,视觉模拟量表评分,和C2-7Cobb角与术前值(日本骨科协会从11.06[1.00]到15.38[1.09],颈部残疾指数从30.75[3.49]到14.81[2.93],视觉模拟量表从5.19[1.60]到1.88[0.96],和从11.97[4.63]到15.49[4.06]的C2-7Cobb角,分别;P<0.05)。3D显微镜辅助ACDF在减压手术时间方面表现出明显的优势,术中失血,后纵韧带的暴露和切除,和并发症发生率,在脊髓型颈椎病的治疗中获得满意的短期治疗效果。在3D显微镜的辅助下,ACDF手术提供了一个高清晰度的视野,提高了精度,从而降低手术风险并改善临床结果。这项技术减轻了外科医生的身体压力,促进协作团队合作,促进教育交流。由于学习曲线相对较短,3D显微镜显着提高了ACDF程序的安全性和效率。
A plethora of studies has substantiated the remarkable clinical efficacy of anterior cervical discectomy and fusion (ACDF) in the treatment of cervical spondylotic myelopathy.1,2 This procedure effectively removes the posterior osteophytes and protruding nucleus pulposus, achieving direct decompression of the spinal cord and effectively alleviating compression symptoms. Concurrently, by distracting the intervertebral space, ACDF contributes to the restoration of the physiological curvature of the cervical spine. However, several pressing issues remain to be addressed during the surgical process. The depth of the surgical field and the lighting conditions often limit the clear identification of the spinal cord and surrounding delicate structures, compounded by the limited operating space and potential interference between the primary surgeon and assistants, all of which may increase surgical risks.3,4 To surmount these challenges, the application of three-dimensional (3D) microscopy in anterior cervical surgery has been proven to be an effective solution. In Video 1, we demonstrate the complete 2-stage ACDF operation under 3D microscopy, where both the primary surgeon and the assistant observe the surgical area through monitors and external screens, ensuring a comfortable posture and good coordination. In our retrospective review, we analyzed 16 ACDF cases aided by 3D microscopy(including both cervical spondylotic myelopathy with disc herniation and cases with spinal instability). Based on the results of the normality test, we use mean (SD) to describe the data. The mean (SD) decompression time was 37.06 (13.30) minutes, with overall surgical duration of 114.56 (18.11) minutes and blood loss of 68.13 (21.36) mL, with no surgically related complications. At the 6-month follow-up, there was a significant improvement in the Japanese Orthopaedic Association score, neck disability index score, visual analog scale score, and C2-7 Cobb angle compared with preoperative values (Japanese Orthopaedic Association from 11.06 [1.00] to 15.38 [1.09], neck disability index from 30.75 [3.49] to 14.81 [2.93], visual analog scale from 5.19 [1.60] to 1.88 [0.96], and C2-7 Cobb angle from 11.97 [4.63] to 15.49 [4.06], respectively; P < 0.05). 3D microscopy-assisted ACDF demonstrated clear advantages in terms of decompression operation time, intraoperative blood loss, exposure and resection of the posterior longitudinal ligament, and complication rate, achieving satisfactory short-term therapeutic outcomes in the treatment of cervical spondylotic myelopathy. Assisted by 3D microscopy, ACDF surgery offers a high-definition visual field that enhances precision, thereby reducing procedural risks and improving clinical outcomes. This technology alleviates the physical strain on surgeons, fosters collaborative teamwork, and facilitates educational exchanges. With a relatively short learning curve, 3D microscopy significantly enhances the safety and efficiency of ACDF procedures.