Percutaneous Endoscopic Keyhole Surgery For Cervical Spondylotic Radiculopathy

Objective(s): To compare the symptom relief of patients with single-segment cervical spondylotic radiculopathy(CSR)after cervical keyhole surgery(keyhole technique)and anterior cervical discectomy decompression and fusion(ACDF),respectively,To analyze the therapeutic effect and clinical application value of cervical keyhole surgery under percutaneous endoscope in single-segment CSR.Methods: We selected patients with single-segment cervical spondylotic radiculopathy who underwent cervical spine surgery in our hospital from September2020 to September 2022 as the research subjects.According to the inclusion criteria,a total of 52 patients were included and divided into two groups using a random number table method: the ACDF surgery group and the percutaneous endoscopic cervical keyhole surgery group.After admission,imaging examinations including cervical X-ray,CT,and MRI were performed.Laboratory examination: preoperative infection indicators,blood cell analysis,etc;Classic symptoms,signs,and imaging examinations are used to clarify the diagnosis,determine surgical indications,and exclude related contraindications.Patient information is collected and preoperative planning is done.There was no statistically significant difference between the two groups in basic information such as age,gender,preoperative pain visual analog scale(VAS),preoperative cervical spine Japanese Orthopedic Association(JOA),and surgical segment(p>0.05).Both groups of patients underwent surgery under general anesthesia.The cervical keyhole surgery group underwent surgery in a prone position under percutaneous endoscopy,while the ACDF group underwent surgery in a supine position.Comparative indicators:(1)intraoperative indicators: surgical time,surgical segment,intraoperative bleeding volume;(2)Perioperative indicators: length of hospital stay;Cervical JOA score before and 1 week and 3 months after surgery;VAS score and improvement rate of upper limb and neck shoulder pain in patients before and 1 day,1 week,1 month,and 3 months after surgery;VAS pain score at each follow-up time point;The incidence of complications;(3)Review indicators: X-ray films were taken 6 months after surgery to measure the cervical flexion and extension range of motion and the Cobb angle of lordosis;Scientifically analyze the cervical spine function of patients 6 months after discharge using the Neckdisability Index score(NDI)to determine if there is any dysfunction,and evaluate the improvement of neck and upper limb function after surgery;Six months after discharge,the incidence rate of axial symptoms was calculated and compared between the two groups based on the evaluation criteria for axial symptoms.Spss 28.0 was used to analyze the data,and the mean and standard deviation of the measurement data with normal distribution were calculated;The median(P25,P75)of non normal distribution data showed that the difference was statistically significant with p<0.05.The categorical data were analyzed using chi square test,and the difference of p<0.05 was statistically significant.Results: All the patients were successfully operated and no major surgical safety accidents occurred.One patient in the ACDF group felt dysphagia without hoarseness after surgery.After surgery,the patient was treated with atomization,expectorant,dehydration and other conservative treatment,and was discharged.After discharge,the throat discomfort gradually disappeared.At the same time,one patient in the ACDF group suffered from temporary numbness and pain of the affected limb after operation,without significant muscle strength reduction.In the keyhole group of cervical spine,2 patients suffered from temporary numbness and pain of the affected limb after operation under percutaneous endoscope,and were treated with dehydration,analgesia,nutrition,rehabilitation and other symptomatic treatment.The symptoms of patients with transient limb pain and numbness in the ACDF group disappeared within seven days and were discharged from hospital.The symptoms of patients in the cervical keyhole group were also completely eliminated within half a month after the operation under the percutaneous endoscope,which was considered to be caused by nerve root traction stimulation during the operation.In the cervical keyhole group,due to the full decompression of the ventral and dorsal sides of the nerve root under the percutaneous endoscope,there will be more traction and disturbance to the nerve root during the operation.The water pressure and water temperature will also stimulate the nerve root during the operation,and the recovery of nerve stimulation symptoms after the operation is relatively slow.The patients in the ACDF group were treated with rehydration,dehydration,anti-infection,nutritional nerve and other symptomatic treatment after operation.The cervical keyhole group did not need anti-infection and excessive rehydration under percutaneous endoscope,but only dehydration and nutritional nerve treatment.The patients in the two groups recovered well after operation,without other adverse symptoms.In the first and last follow-up after the operation,the VAS scores of the neck,shoulder and affected limb in both groups were significantly lower than those before the operation,and the JOA scores of the cervical spine in both groups were significantly higher than those before the operation.There was no significant difference in the Cobb angle of cervical lordosis between the two groups before operation(P>0.05).At the same time,the NDI score of the last follow-up of the two groups showed that there was no obvious cervical dysfunction,and there was no obvious axial symptoms after operation.The slight axial symptoms were improved by symptomatic treatment,which proved that the two methods of manual surgery had good efficacy,safety and reliability in the treatment of single-level cervical spondylotic radiculopathy.The review of postoperative cervical spine mobility showed that the cervical spine mobility of patients with ACDF surgery had a certain loss compared with that of the percutaneous endoscopic keyhole group(P<0.05),and the patients in the percutaneous endoscopic cervical keyhole group had less bleeding at the same time during the operation,less postoperative pain at the mouth,shorter hospitalization and recovery time,which proved that the percutaneous endoscopic cervical keyhole surgery had less trauma and faster recovery compared with the ACDF surgery,It can better maintain the advantages of cervical mobility,and there are also more cases of nerve root disturbance and stimulation.It is necessary to accumulate rich experience and operate carefully to avoid this situation.Conclusion(s): Through this study,it can be concluded that ACDF and percutaneous endoscopic cervical keyhole surgery have obvious clinical efficacy in the treatment of single-segment cervical spondylotic radiculopathy,and the effect is similar.However,compared with ACDF surgery,percutaneous endoscopic cervical keyhole surgery has the advantages of less damage,better maintenance of cervical mobility,clearer field of vision during operation,more sufficient decompression of the ventral and dorsal sides of the nerve root,and so on,It is worthy of clinical promotion as a preferred supplementary method for the treatment of cervical spondylotic radiculopathy.At the same time,this technology also has more cases of nerve root traction stimulation,which needs to be further verified by a larger sample size control experiment.