| Objective:The aim of this study was to compare the clinical efficacy of endoscopic spinal surgery with anterior cervical decompression and fusion in the treatment of cervical spondylotic myelopathy.Methods:A total of 46 cervical spondylotic myelopathy patients who were admitted to the Medical School of Chinese PLA and treated with endoscopic spine surgery or anterior cervical decompression and fusion from January 2015 to June 2017 were collected.General informations of the selected cases were collected,including gender and age,etc.The patients were divided into the spinal endoscopy group and the anterior cervical decompression and fusion group(ACDF group),according to the operation methods.All patients had typical clinical manifestations of cervical spondylotic myelopathy,and preoperative X-ray,CT and MRI examinations of the cervical spine were completed.The operation lasting time,intraoperative blood loss and hospitalization stay of the two groups were recorded and compared.Japanese Orthopedic Association(JOA)score before operation,three months and one year after operation were recorded between two groups.The differences of JOA score at preoperative and postoperative time points between the two groups were analyzed by repeated measures anova and simple effect test.The improvement rate of JOA score three months and one year after operation were compared between the two groups,and the clinical efficacy one year after operation was evaluated further.Results:1.There were 22 patients in the spinal endoscopy group with an average age of46.55±9.37 years,and 24 patients in the ACDF group with an average age of 42.41±9.82 years.There was no significant difference in age,gender,symptoms and signs between these two groups(P>0.05).The efficacy of these two groups was comparable.2.The mean operation lasting time and hospitalization stay were significantly shorter in the spinal endoscopy group((70.23±10.91)mins,(4.23±1.11)days)than that in the ACDF group((92.29 ±13.13)min,(8.21±1.50)days)(P<0.05).And the mean intraoperative blood loss was significantly less in the spinal endoscopy group((30.00±7.30)ml)than that in the ACDF group((132.38 ±14.33)ml)(P<0.05).3.There were no significant differences in the JOA score before operation(9.76±0.97 vs 9.63±1.06),three months(13.47±0.71 vs 13.54±0.63)and one year(14.25±0.61 vs14.40± 0.64)after operation between the spinal endoscopy group and the ACDF group(P>0.05).The JOA score three months and one year after operation were significantly higher than those before operation both in two groups,and there was no significant difference in the JOA score three months and one year after operation(P>0.05).The improvement rate three months((51.52±5.86)% vs(53.16±4.54)%)and one year((62.00±7.82)% vs(65.11±5.02)%)after operation in the spinal endoscopy group was no significantly difference compared to those in the ACDF(P>0.05).4.The excellent rate of clinical efficacy evaluation was no significant difference between the spinal endoscopy group(81.8%)and the ACDF group(83.3%)(P>0.05).In the group of spinal endoscopy,decompression failed in one case,whose symptoms disappeared after anterior decompression and fusion.One case of postoperative C5 nerve root paralysis was treated with conventional dehydration and one case of wound hematoma complicated by anti-infection treatment and wound healing after debridement and suture inthe ACDF group.Conclusion:The short-term efficacy of spinal endoscopic surgery and anterior cervical decompression and fusion was equal in the treatment of cervical spondylotic myelopathy.Spinal endoscopic surgery was significantly superior to anterior cervical decompression and fusion in reducing the operation lasting time,the intraoperative blood loss and the hospitalization stay. |
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