Clinical Application Of Nerve Root Decompression With Anterior Transdiscal Percutaneous Endoscopic Surgery For Cervical Spondylotic Radiculopathy

Background: Although anterior cervical discectomy and fusion is the gold standard for treatment of cervical spondylosis, but it will lead to adjacent vertebral degeneration, loss of intervertebral height and complications such as pseudarthrosis and other serious consequences. Using percutaneous endoscopic disctomy to treat cervical spondylosis with soft-press such as cervical intervertebral disc herniation can be effectively and reduce the complications of anterior cervical discectomy and fusion at the same time, but the traditional percutaneous endoscopic cervical disctomy is mainly used for treating cervical spondylosis with soft-press, while the effect of treating cervical spondylosis with rigid-press such as osteoproliferation is poor. In recent years the development of surgical instruments and surgical technique that using microscopically drill grinding osteophyte make it possible to treat cervical spondylosis with rigid-press.Objective:To evaluate the feasibility,safety,and clinical outcome in patients with cervical spondylotic radiculopathy underwent cervical foraminoplasty and cervical nerve root decompression with transdiscal anterior percutaneous endoscopy.Methods: From July 2012 to December 2013,11 patients(6 men and 5 women, age ranged from 27 to 63 years old, mean 42.1 years old) were treated with anterior transdiscal percutaneous endoscopic cervical nerve root decompression. Corresponding symptom was segmental radicular pain caused by nerve root compression, 1 case at C3/4, 2 case at C4/5, 6 case at C5/6 and 2 case at C6/7, the effect of non-surgical treatment of 6 weeks is poor, the images of these cases showed no spinal cord compression. All patients were in the supine position under general anesthesia. The osteophyte was removed by electric diamond burr, controlled with the anterior percutaneous endoscopy. Then the nerve root was released. The duration time of operation and postoperative complications were recorded. Visual analogue scale(VAS) were recorded before surgery and at 3 days,1,3,6 and 12 months postoperative, and modified Mac Nab criteria were recorded postoperative 12 months. In addition, CT examination were conducted after surgery.Results: The time of operation was 63.5±20 minutes, and no one of complications. Follow-up 12 months was achieved in 9 patients. 2 cases were lost because of the changing of contact information. The VAS scale score at preoperative, postoperative 3 days,1,3,6,12 months was(80.5±17.7),(43.2±7.9),(41.2±11.8),(38.6±8.5),(37.4±14.7),(35.1±8.7).When compared to the preoperative score,VAS scale presented great improvement at postoperative 3 days,1,3,6,12 months(t=5.773,5.542,6.402,5.620,6.906,P<0.01).When compared to the preoperative score,modified Mac Nab criteria showed that excellent in 8 patients, good in 1 patients.Conclusion: Cervical nerve root decompression with anterior transdiscal percutaneous endoscopic surgery is safety, effective and technically feasible. It is one of the minimally invasive surgical choices to treat cervical spondylotic radiculopathy.