Comparison Of Outcomes Between Spinal Endoscopic Unilateral Laminectomy And ACDF For Cervical Spinal Stenosis

Objectives: To compare the clinical efficacy of endoscopic unilateral laminectomy with ACDF in the treatment of cervical spinal stenosis.Methods: From January 2015 to December 2019,50 patients with single or double level cervical spinal stenosis who were admitted to the sixth medical center of PLA General Hospital and treated by anterior cervical discectomy and fusion or endoscopic unilateral laminectomy were analyzed retrospectively.Among them,26 patients underwent anterior cervical discectomy and fusion(ACDF group)and 24 patients underwent endoscopic unilateral laminectomy(endoscopic group).The general information of the selected cases were collected,including age,gender,etc.And the operation lasting time,intraoperative blood loss,hospitalization time of the two groups were recorded and compared;JOA score,NDI and VAS score were recorded before operation and at the last follow-up,and the improvement rate of JOA was compared between the two groups at the last follow-up,and the clinical efficacy of the patients at the last follow-up was evaluatedResults: 1.There were 13 males and 11 females in the endoscopy group with an average age of 56.9±13.4 years(18 patients with single level,6patients with double levels),and 13 males and 13 females in the ACDF group with an average age of 55.0±11.4 years(19 patients with single level,7 patients with double levels).There was no significant difference in age,gender,symptoms and signs between these two groups(P>0.05).The efficacy of these two groups was comparable.2.The mean operation lasting time was(76.9±27.7)min,intraoperative blood loss was(9.9±6.1)ml,hospitalization stay was(5.1±1.7)d in the endoscopy group;The mean operation lasting time was(118.0 ± 23.3)min,intraoperative blood loss was(52.3 ±30.6)ml,hospitalization stay was(10.4±2.7)d in the ACDF group;There was significant difference in operation lasting time,intraoperative blood loss and hospitalization stay between these two groups(P<0.05).3.The JOA score,NDI and VAS score preoperative was(9.0±1.4),(45.3±10.5)% and(6.6±0.2)in endoscopy group;The JOA score,NDI and VAS score preoperative was(8.9±1.7),(47.4±9.5)% and(7.1±0.1)in ACDF group;The JOA score,NDI and VAS score at the last follow-up was(13.8±1.5),(12.7±5.9)% and(2.9±1.2)in endoscopy group;The JOA score,NDI and VAS score at the last follow-up was(13.9±1.6),(12.6±7.0)%and(2.8±1.2)in ACDF group;There was no significant difference in JOA score,NDI and VAS score between these two groups both preoperative and the last follow-up(P>0.05).There was significant difference in JOA score,NDI and VAS score between preoperative and the last follow-up both ACDF group and endoscopy group(P<0.05).The JOA recovery rate at the last follow-up was(59.7±18.1)% in endoscopy group;The JOA recovery rate at the last follow-up was(61.1±16.6)% in ACDF group;There was no significant difference in JOA recovery rate between these two groups(P>0.05).4.The excellent rate of clinical effect evaluation was no significant difference between the endoscopy group(75%)and the ACDF group(80.8%)(P>0.05).There was no patient occurred complications in endoscopy group;One patient had hoarseness and returned to normal 2 months after operation in the ACDF group.Conclusions: 1.Endoscopic unilateral laminectomy and ACDF can get same curative effects in the treatment of cervical spinal stenosis.2.Compared with ACDF,endoscopic unilateral laminectomy has the advantages of shorter operation lasting time,shorter hospital stay and less intraoperative blood loss.