| Background: Cervical disc herniation is a common cervical spondylosis.Due to the popularity of computers and smart phones in recent years,the incidence of cervical disc herniation has also been increasing year by year and younger.Most of the patients’ symptoms can be relieved after standard conservative treatment,but some patients whose conservative treatment is ineffective or show progressive aggravation require surgical intervention.At present,anterior cervical decompression and fusion is the standard surgical procedure for the treatment of cervical disc herniation,but the complications related to this surgical approach and the degeneration of adjacent vertebrae cannot be avoided.Posterior cervical percutaneous total endoscopic discectomy is a new surgical method that has emerged in recent years.It has the characteristics of less trauma and less complication.It is considered to be one of the effective alternatives to ACDF and has a good Application prospects.Objective: To compare the efficacy of posterior cervical percutaneous total endoscopic discectomy and anterior cervical discectomy and fusion in the treatment of single-segment lateral and paracentral cervical disc herniation,as well as the effect on cervical spine range of motion and stability,adjacent segment degeneration.Methods: According to the inclusion and exclusion criteria,the case data of patients with cervical disc herniation who underwent PPECD and ACDF surgery in our hospital from August 2018 to November 2019 were screened,and the case data of 75 patients who met the criteria were retrospectively analyzed.The cases were divided into PPECD group(n=39)and ACDF group(n=36)according to the surgical method.Compare the baseline conditions of the two groups of patients,such as age,gender,and surgical segment.The cervical visual pain score,upper limb visual pain score,cervical spine dysfunction index,postoperative complications,cervical spine range of motion and stability,and adjacent segment degeneration were compared between the two groups before surgery,one month after surgery,and one year after surgery.Results: The operation time of the PPECD group was longer than that of the ACDF group,and the difference was statistically significant(P<0.05).The intraoperative blood loss,postoperative hospital stay and hospitalization expenses in the PPECD group were smaller than those in the ACDF group,and the difference was statistically significant(P<0.05).The neck VAS score,upper extremity VAS score,and neck NDI score of the two groups of patients were lower than before the operation at 1 month after operation,and the difference was statistically significant(P<0.05).The neck VAS score,upper limb VAS score,and neck NDI score decreased 1 year after surgery compared with those before and 1 month after surgery,the difference was statistically significant(P<0.05).The neck VAS score,upper limb VAS score,and neck NDI score in the PPECD group were lower than those in the ACDF group at 1 month after surgery,the difference was statistically significant(P<0.05).There was no significant difference in neck VAS score,upper limb VAS score,and neck NDI score between the two groups one year after surgery(P>0.05).There was no statistically significant difference in the incidence of complications between the two groups(P>0.05).The range of motion of the upper vertebral body and the overall range of cervical spine motion of the two groups of patients in the first month after the operation increased compared with that before the operation,and the operation in the first year after the operation increased compared with that before the operation and the first month after the operation(P>0.05).The PPECD group had no significant difference in the lower vertebral motion of the operative segment before operation,1 month after operation,and 1 year after operation(P>0.05).In the ACDF group,the range of motion of the lower vertebral body at the surgical segment increased in the first month after surgery compared with that before the operation,and the range of motion of the lower vertebral body in the surgical segment increased at 1 year after the operation compared with that before and 1 month after the operation.The difference was statistically significant(P <0.05).There was no significant difference in the range of motion of the upper and lower vertebral bodies between the two groups at 1 month after surgery(P>0.05).The overall range of motion of the cervical spine in the ACDF group was smaller than that in the PPECD group,and the difference was statistically significant(P<0.05).The range of motion of the upper and lower vertebral bodies in the ACDF group was larger than that of the PPECD group at 1 year after operation,and the difference was statistically significant(P<0.05).There was no significant difference in the overall range of motion of the cervical spine between the two groups(P>0.05).There was no significant difference in the angle and horizontal displacement of adjacent intervertebral vertebrae of the operation segment before and 1 year after operation in the PPECD group(P>0.05).The angle and horizontal displacement of adjacent intervertebral vertebrae of the surgical segment were less than the reference value at 1 year after operation,and the difference was statistically significant(P<0.05).There was no significant difference in the degeneration of adjacent cervical segments between the two groups at 1 year after operation(P>0.05).Conclusion: Both PPECD and ACDF can significantly improve the clinical symptoms of patients with cervical disc herniation.However,the PPECD operation is less traumatic,less expensive,and has certain advantages in maintaining the stability of the patient’s cervical spine after surgery. |
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