Comparative Analysis For Clinical Effects Of Keyhole Technique With Two Endoscopic Treatments For Cervical Disc Herniation

Object:Posterior percutaneous endoscopic cervical discectomy（P-PECD）is an effective surgical method for the treatment of cervical spondylosis.The diameter of its working channel has varied from 3.7 mm to 6.9mm.However,to date,there is no literature comparing the clinical efficacy of different caliber endoscopes in patients with cervical disc herniation（CDH）.The purpose of our study was to compare clinical outcomes of patients,who suffered from unilateral CDH,treated with P-PECD technique using two different diameters endoscope,which are3.7 mm endoscope and a 6.9 mm endoscope respectively.Methods:The patients included in our study were unilateral radiculopathy and admitted to our hospital from June 2016 to April 2021,totally 42 patients.P-PECD was performed with 3.7mm or 6.9mm endoscope,respectively.Among the included patients,we used 3.7mm endoscope for 18 patients,and 6.9mm endoscope for 24 patients.Postoperative clinical outcomes were evaluated,including operation time,length of stay,visual analogue scale（VAS）score,modified Macnab standard and postoperative complication.Results:By precise intraoperative timing,between the 3.7 mm endoscope group and the 6.9 mm endoscope group,there was a significant difference in regard to the average identification time of the“V”point（17.50±3.99 min vs.10.16±1.99 min,p< 0.01）.Besides,the mean removal time of the overlying soft tissue（16.01±3.02 min vs.11.64±2.62 min,p< 0.05）was significant differences between the two groups,respectively.Additionaly,we performed VAS and modified Macnab scores on all included patients before surgery,and postoperatively,we also carried out the same scoring criterias 1 day before surgery and 1,3,6,12 month after surgery.According to VAS or the modified Macnab scores,two endoscopes groups were significantly improved compare to the preoperative scores（p< 0.05）,which means that the patient all achieved significant efficacy.Conclusions:Both 3.7 mm endoscope and 6.9 mm endoscope were selected as an effective method for the treatment of CDH and there was no significant difference in clinical efficacy between the two endoscopes.Among them,6.9mm endoscope is superior to 3.7mm endoscope in “V” point recognition efficiency,removing the overlying soft tissue.Nevertheless,the large diameter of 6.9mm endoscope may be inferior to3.7mm endoscope in the decompression of the front of spinal cord.Complications may occur in both methods.Therefore,for the treatment of patients with unilateral radiculopathy,comprehensive evaluation should be carried out according to the clinical manifestations,specialized physical examination and imaging examination of patients,in orders to develop safe,individual and effective treatment plan,achieve the expected surgical effect.