Acomparative Cohort Study Of Two Different Approaches Of Percutaneous Endoscopic Cervical Discectomy For Cervical Intervertebral Disc Herniation

Objective: Through comparing the outcomes of patients withsymptomatic CIVDH treated with PECD in anterior approach or posteriorapproach, the ideal approach of PECD for symptomatic CIVDH isacquired.Methods: From March2010to July2012, a total of84consecutivepatients with symptomatic single-level CIVDH who were operated byPECD in anterior approach (42patients) or posterior approach (42patients)were enrolled. Patients were assessed neurologically before surgery andcontrolled later at regular outpatient. The clinical outcomes were evaluatedusing the VAS and modified MacNab criteria. Radiographic follow-upincluding the static and dynamic cervical plain, CT scan and MRI was usedfor observing the change in intervertebral vertical height of surgicalsegment and whether the postoperative instability or increasing kyphosiswas occurred.Results: In both groups, the shorter mean operational duration (63.5mins vs.78.5mins), the more mean volume of removal disc (0.6g vs.0.3g), the more mean decrease in final postoperative mean intervertebralvertical height (1.0mm vs.0.5mm) and the longer mean hospital stay (4.9days vs.4.5days) were found in AFECD group. Postoperatively, theclinical outcomes of two approaches were improved significantly, but the differences between of both groups weren’t significant (p=0.211, p=0.257,respectively). There were totally four surgery-related complications for theall enrolled patients (2in anterior,2in posterior,4of84,4.8%).Conclusions: In our study, the clinical outcomes between twoapproaches were not different significantly. Nevertheless, when consideringthe volume of removal disc, length of hospital stay and postoperativeradiographic change, PPECD may be preferable. As an efficacioussupplement to traditional open surgery, PECD is a reliable alternativetreatment for CIVDH and its optimal approach is still open for discussion.