Clinical Efficacy Of Endoscopic Posterior Cervical Laminoplasty In The Treatment Of CSM

Objective:To compare the clinical efficacy of Endoscopic posterior cervical laminoplasty(posterior percutaneous endoscopic decompression)and anterior cervical discectomy and fusion in the treatment of single-segment cervical Spondylotic myelopathy.Methods:From January 2020 to January 2021,consecutive patients who were diagnosed with cervical spondylotic myelopathy in the Department of Spine of the Our hospital.A total of 51 cases met the inclusion criteria,and 38 cases were finally screened out according to the exclusion criteria.According to different surgical methods,they were divided into endoscopic group group and open group.The endoscopic group received Endoscopic posterior cervical laminoplasty(18 cases),and the open group received anterior cervical discectomy,decompression and fusion.surgery(20 cases).The general data of the two groups of patients were compared;the operation time,incision size and hospitalization time of the two groups of patients;the Janpanse Orthopedic Association(JOA)score,neck Visual Analogue Scale(VAS)score,Neck Disability Index(NDI)score;modified Mac Nab score in postoperative functional improvement.Results:In our current research,there were 38 patients in the two groups,18 in The endoscopic group and 20 in the open group.There was no statistically significant difference in seven factors including number of people,age,sex,underlying disease,course of disease,lesion location,and follow-up time(P > 0.05).The operation time in The endoscopic group(65.56±5.91)minutes was shorter than that in the open group(108.75±15.38)minutes,and the difference was statistically significant(P < 0.05).The length of hospitalization in the open group(8.45±1.10)d was significantly longer than that in The endoscopic group(4.72±0.82)d,and the difference was statistically significant(P < 0.05).In terms of incision size,The endoscopic group was significantly smaller than the open group,and the difference was statistically significant(P < 0.05).In comparison within the group,the neck VAS scores and NDI scores of The endoscopic group at 1 month,3 months,6 months,and 12 months after surgery were lower than those before surgery,and the differences were statistically significant(P< 0.05).The JOA score at 1 month,3 months,6 months,and 12 months after operation in The endoscopic group was higher than that before operation,and the difference was statistically significant(P < 0.05).The JOA score,neck VAS score,and NDI score at 1month,3 months,6 months,and 12 months after operation in the open group were significantly different from those before operation(P < 0.05).Compared between the groups,the JOA score and NDI score of neurological function in The endoscopic group at 1 month,3 months,6 months,and 12 months after operation were not significantly different from those in the open group(P > 0.05).The neck VAS score at 1 months and3 months was significantly lower than that of the open group,the difference was statistically significant(P < 0.05),and there was no significant difference in neck VAS scores between the two groups at 6 months and 12 months after operation(P > 0.05).The modified Mac Nab score at the last follow-up in The endoscopic group: excellent in9 cases,good in 7 cases,effective in 2 cases,and poor in 0 cases,with an overall excellent and good rate of 88.9%;the modified Mac Nab score at the last follow-up in the open group: excellent in 13 cases,good There were 6 cases,1 case was effective,and 0 case was poor.The overall excellent and good rate was 95%.There was no significant difference between The endoscopic group and the open group(P > 0.05).Comparison of complications: There was no postoperative complication in The endoscopic group,and 1 case of transient dysphagia occurred in the open group,and the symptoms disappeared after 1 month of follow-up;After conservative treatment,the symptoms disappeared after 3 months.Conclusion:Endoscopic posterior cervical laminoplasty for the treatment of single-segment cervical spondylotic myelopathy has the advantages of less trauma,shorter operation time and shorter hospital stay.It can achieve the same clinical effect as that of anterior cervical discectomy,decompression and fusion.In summary,under the premise of strict surgical indications,this minimally invasive technique can achieve good clinical results in the treatment of cervical spondylotic myelopathy,providing a new treatment option for spinal surgeons.