| Background and ObjectiveRecently,it has been reported that reabsorption of herniated cervical intervertebral disc occurred in patients after expansive open-door laminoplasty(EOLP),but whether there are other surgical methods that can cause reabsorption of cervical intervertebral disc and whether EOLP has more advantages than other operations on the reabsorption of herniated cervical intervertebral disc has not been reported.By observing the phenomenon of reabsorption of herniated cervical intervertebral disc after cervical microendoscopic laminoplasty(CMEL)and EOLP,the purpose of this study was to analyze the characteristics of reabsorption of herniated cervical intervertebral disc after minimally invasive cervical laminoplasty(EOLP)and explore its possible mechanism,so as to provide a new research direction and idea for the reabsorption of herniated cervical intervertebral disc.MethodsA total of 77 patients underwent CMEL and single cervical open-door laminoplasty:There were 37 patients in the CMEL group,including 22 males and 15 females,aged from 37 to 63 years(mean 51 years),the course of disease ranged from 2 months to 11 months(mean 5 months),and there were 17 patients with three segments of cervical disc herniation,17 patients with four segments and 3 patients with five segments.There were 40 patients in the single cervical open-door laminoplasty group,including 16 males and 24 females,aged from 39 to 60 years(mean 49 years),and the course of disease ranged from 3 months to 12 months(mean 6 months).There were 18 cases of three-segment cervical disc herniation,20 cases of four-segment cervical disc herniation and 2 cases of five-segment cervical disc herniation.Patients in both groups were examined by MRI before operation,before discharge and at 3,6 and 12 months after operation.All patients were diagnosed after X-ray,CT and MRI imaging examination in our hospital,it can be seen that each segment of cervical intervertebral disc has varying degrees of degeneration and herniation,complicated with sagittal diameter stenosis of spinal canal,all selected cases have serious neurological symptoms,and are ineffective after strict conservative treatment,so surgical treatment is chosen.The study was in line with the Helsinki Declaration and all patients signed informed consent forms.The volume of herniated cervical intervertebral disc was measured by PACS software,and the measurement results were evaluated by absorption ratio,absorption rate,absorbance and other factors.Results(1)There was no significant difference in the baseline data between the CMEL group and the EOLP group in terms of age,sex,course of disease and the number of patients with three,four and five segments of cervical disc herniation(P>0.05).This study is comparable.(2)In CMEL group,the average volume of intervertebral disc herniation before and after operation was 245.65 ± 61.36 mm3and 162.54±48.93 mm3,respectively.There was significant difference in the volume of intervertebral disc herniation before and after operation(P<0.05).In EOLP group,the average volume of intervertebral disc herniation before and after operation was 222.96±61.24 mm3 and 195.46±54.42 mm3,respectively.There was significant difference in the volume of intervertebral disc herniation before and after operation(P<0.05).(3)The absorption ratio of cervical disc herniation in CMEL group and EOLP group were 66.42%(89/134)and 39.58%(57/144),respectively.And the difference was statistically significant(P<0.05).The small absorption ratio of CMEL group and EOLP group were 45.52%(61/134)and 32.64%(47/144),respectively,and the difference was statistically significant(P<0.05).The medium absorption ratio of CMEL group and EOLP group were 18.66%(25/134)and 6.94%(10/144),respectively,and the difference was statistically significant(P<0.05).The mass absorption ratio of CMEL group and EOLP group were 2.24%(3/134)and 0%(0/144),respectively,and there was no significant difference between the two groups(P>0.05).(4)In CMEL group and EOLP group,the absorptive ratios of C2/3,C3/4,C4/5,C5/6 and C6/7 segmental herniated intervertebral discs were 66.67%(2/3),53.85%(14/26),68.75%(22/32),75.68%(28/37),63.89%(23/36)and 50%(1/2),41.94%(13/31),45.95%(17/37),35%(14/40),35.29%(12/34).There was no significant difference in the absorption ratio of cervical disc herniation between the two groups(P>0.05).(5)In CMEL group,the absorption ratios of ruptured and inclusive herniated intervertebral discs were 81,97%(50/61)and 53.42%(39/73),respectively.And those of lateral and central herniated discs were 87.10%(27/31)and 60.19%(62/103),respectively.In the EOLP group,the absorption ratios of ruptured and inclusive herniated intervertebral discs were 61.33%(46/75)and 15.94%(11/69),respectively.And those of lateral and central herniated intervertebral discs were 58.62%(17/29)and 34.78%(40/115),respectively.There were significant difference in the absorption ratio of ruptured and inclusive disc herniation in each group(P<0.05),and there were significant difference in the absorption ratio of central disc herniation and central disc herniation in each group(P<0.05).(6)There was no postoperative reprotrusion of herniated intervertebral disc in CMEL group,and 5 herniated discs were found in EOLP group.The reprotrusion ratio of the two groups was 0%and 3.47%,respectively.There was no significant difference in the ratio of postoperative reprotrusion of herniated intervertebral disc between the two groups(P>0.05).Conclusions(1)In terms of reabsorption of herniated cervical intervertebral disc,both CMEL and EOLP can promote the reabsorption of herniated cervical intervertebral disc,and the effect of CMEL on the reabsorption of herniated cervical intervertebral disc is significantly better than that of EOLP.(2)Both of CMEL and EOLP,the reabsorption of herniated cervical intervertebral disc is not limited by the segment of herniated cervical intervertebral disc,that is,any segment of herniated cervical intervertebral disc can be reabsorbed.(3)All types of herniated cervical intervertebral discs can be reabsorbed after CMEL and EOLP,but ruptured and lateral herniated intervertebral discs are more likely to be reabsorbed than inclusion and central herniated intervertebral discs. |
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