Comparison Of Clinical Efficacy Between PPECD And ACDF For Cervical Spondylotic Radiculopathy

Objective: To compare the clinical efficacy of posterior percutaneous full-endoscopic cervical discectomy versus anterior cervical discectomy and fusion in the treatment of cervical spondylotic radiculopathy.Methods: Retrospective analysis of 42 cases of cervical spondylotic radiculopathy in February 2015-September 2016,including 22 cases of PPECD operation,and 20 cases of ACDF operation.There were no statistically significant differences in age,sex,disease duration,lesion segment,preoperative visual analogue scale(VAS),preoperative Neck disability index(NDI),physiological curvature and adjacent segment degeneration between 2 groups(P>0.05).The operation time,intraoperative bleeding,fluoroscopy time,incision length,hospitalization time,bed time,hospitalization expenses and postoperative complications were compared between 2 groups.The VAS score and NDI were observed during follow-up.Imaging data of 24 patients were followed up,including the PPECD group(13 cases)and the ACDF group(11 cases).To evaluate the changes of intervertebral space height by measuring the disc height index in the preoperative and last follow-up of the PPECD group.To evaluate the stability of the PPECD group,the relative angle and displacement of sagittal plane were measured in the preoperative and last follow-up.In both groups,the physiological curvature of the cervical vertebrae was evaluated in preoperative and last follow-up.The degeneration of the adjacent segment of the two groups was evaluated by using the X-ray Kellgren degenerative grading standard in the preoperative and last follow-up.The excellent and good rates of the two groups were compared according to the Odom’s grading method.Results: The PPECD group had a decreased intro-operative blood loss and length of incision,shortened post-operative bed time and hospitalization time,and increased operative time and intraoperative radiological exposure time,showing significant differences when compared with the ACDF group(P<0.05).The neck VAS score of the PPECD group was lower than that of the ACDF group in postoperative 2 hours,1 week,1 month and 3 month(P<0.05).The upper limb VAS score of the PPECD group in postoperative 2 hours and 1 week was lower than that of the ACDF group(P<0.05).The NDI of PPECD group in postoperative 1 week and 1 month was lower than that of ACDF group(P<0.05).The incidence of complication was 13.64%(3/22)in PPECD group and was 10%(2/20)in ACDF group,and there was no statistically significant difference between the two groups(P>0.05).The disc height index of the PPECD group in last follow-up was lower than that before the surgery,but they were no statistically significant(P>0.05).The relative angle and displacement of the sagittal plane in the operative segment of the PPECD group in the last follow-up was higher than that before the surgery,but they were no statistically significant(P>0.05);and also significantly less than the diagnosis standard reference value of instability(P<0.05).The physiological curvature of the ACDF group in the last follow-up was higher than that of the PPECD group,it was significant statistically(P<0.05).There was no statistically significant difference between the two groups of adjacent segment degeneration(P>0.05).According to the Odom’s grading method,the excellent and good rate of the PPECD group was 86.36%,the excellent and good rate of PPECD group was 85%.There was no significant difference between the two groups.(P>0.05).Conclusion : Both PPECD and ACDF can obtain satisfactory clinical effect in the treatment of cervical spondylopathy of nerve root type.However,PPECD has the advantages of less trauma,faster recovery,less cost and no obvious interference to segmental stability,so it is worth popularizing and applying.