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  • Title: [Clinical study of single-level cervical disc herniation treated by full-endoscopic decompression via anterior transcorporeal approach].
    Author: Yang J, Chu L, Deng Z, Kai-Xuan L, Deng R, Chen H, Liu P, Liu T, Rong X, Hao D.
    Journal: Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi; 2020 May 15; 34(5):543-549. PubMed ID: 32410418.
    Abstract:
    OBJECTIVE: To investigate the clinical feasibility of full-endoscopic decompression for the treatment of single-level cervical disc herniation via anterior transcorporeal approach. METHODS: According to the inclusion and exclusion criteria, 21 patients with cervical disc herniation who received full-endoscopic decompression via anterior transcorporeal approach between September 2014 and March 2016 were retrospectively analyzed. There were 12 males and 9 females with an age ranged from 32 to 65 years, with an average of 48.5 years. The duration of symptoms ranged from 6 to 18 weeks, with an average of 10.5 weeks. According to the Nurick grading of spinal cord symptoms, there were 2 cases with grade 1, 7 cases with grade 2, and 12 cases with grade 3. Operative segment was C 3, 4 in 2 cases, C 4, 5 in 8 cases, C 5, 6 in 9 cases, and C 6, 7 in 2 cases. The operation time and related complications were recorded. The central vertical height of the vertebral body and the diseased segment space were measured on the cervical X-ray film. The neck and shoulder pain were evaluated by visual analogue scale (VAS) score; Japanese Orthopaedic Association (JOA) score was used to evaluate the improvement of neurological function in patients. The MRI of cervical spine was reexamined at 3 months after operation, and the CT of cervical spine was reexamined at 12 months after operation. The decompression of spinal cord and the healing of bone canal in the vertebral body were further evaluated. RESULTS: Full-endoscopic decompression via anterior transcorporeal approach were achieved at all 21 patients. The operation time was 85-135 minutes, with an average of 96.5 minutes. All patients were followed up 24-27 months, with an average of 24.5 months. There was no complication such as residual nucleus pulposus, spinal cord injury, large esophageal vessels injury, pleural effusion, endplate collapse, intraspinal hematoma, cervical spine instability, protrusion of disc in the same segment, or kyphosis. Both VAS scores of neck and shoulder pain and JOA scores were significantly improved at 12 months after operation ( P<0.05). At 3 months after operation, it was confirmed by the cervical MRI that neural decompression was sufficient and the abnormal signal was also degraded in the patients with intramedullary high signal at T2-weighted image. The cervical CT showed that bone healing were achieved in the surgical vertebral bodies of all patients at 12 months after operation. At 24 months after operation, the central vertical height of the diseased segment space significantly decreased compared with preoperative one ( t=2.043, P=0.035); but there was no significant difference in the central vertical height of the vertebral body between pre- and post-operation ( t=0.881, P=0.421). CONCLUSION: Full-endoscopic decompression via anterior transcorporeal approach, integrating the advantages of the endoscopic surgery and the transcorporeal approach, provide an ideal and thorough decompression of the ventral spinal cord with satisfactory clinical and radiographic results. 目的: 探讨前路经椎体内入路全内镜下减压治疗单节段颈椎间盘突出症的临床可行性。. 方法: 回顾分析 2014 年 9 月—2016 年 3 月收治的符合选择标准的 21 例接受前路经椎体内入路全内镜下减压治疗的颈椎间盘突出症患者。男 12 例，女 9 例；年龄 32～65 岁，平均 48.5 岁。症状持续时间 6～18 周，平均 10.5 周。脊髓症状 Nurick 分级 1 级 2 例，2 级 7 例，3 级 12 例。手术节段：C 3、4 2 例，C 4、5 8 例，C 5、6 9 例，C 6、7 2 例。记录手术时间以及相关并发症。手术前后于颈椎 X 线片上测量颈椎手术椎体及病变节段椎间隙中心垂直高度，采用疼痛视觉模拟评分（VAS）及日本骨科协会（JOA）评分评价疼痛及功能改善情况。术后 3 个月复查颈椎 MRI，术后 12 个月复查颈椎 CT，进一步评估患者脊髓减压情况及椎体内骨道愈合情况。. 结果: 21 例患者均顺利完成手术，手术时间 85～135 min，平均 96.5 min。患者均获随访，随访时间 24～27 个月，平均 24.5 个月。未发生髓核残留、脊髓神经损伤、食道大血管损伤、胸腔积液、终板塌陷、椎管内血肿等并发症；随访期间未见同节段椎间盘再突出以及颈椎失稳、后凸畸形等。术后 12 个月颈肩痛 VAS 评分及 JOA 评分均较术前显著改善（ P<0.05）。术后 3 个月颈椎 MRI 示脊髓神经减压充分，硬膜囊无明显受压，T2 像上髓内高信号均较术前有不同程度减退；术后 12 个月 CT 示患者椎体内骨道均实现骨性愈合。术后 24 个月，病变节段椎间隙中心垂直高度较术前下降（ t=2.043， P=0.035），但手术椎体中心垂直高度与术前比较差异无统计学意义（ t=0.881， P=0.421）。. 结论: 前路经椎体内入路全内镜下减压将脊柱内镜与椎体内入路的优势相结合，可对脊髓腹侧提供理想、彻底的减压，并获得满意的临床及影像学结果。.
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