| Objective: Percutaneous posterior endoscopic discectomy(ppecd)and anterior cervical decompression and fusion(ACDF)were compared,ACDF is the main surgical method for the treatment of cervical spondylotic radiculopathy.By comparing the clinical application of the two surgery,this paper discusses the efficacy,advantages,surgical risk points and control strategies of PPECD,so as to provide relevant reference value for clinical treatment.Methods: 92 cervical spondylosis cases treated by percutaneous complete endoscopic posterior cervical discectomy(PPECD)and anterior cervical decompression and fusion(ACDF)in the Department of Orthopedics of Chengdu 363 hospital and Chengdu Zhongshan orthopedic hospital between January 2017 and December 2019 were collected.The patient’s operation time,incision size,length of stay(LOS)were compared,and the degree of incision pain,symptom relief,cervical spine function evaluation and surgical complications were compared and statistically analyzed.The Visual analogue score(VAS)was used to compare the pain of the incision at 6 hours,1 month after the operation,and the pain of the neck and/or upper limbs before the operation,6 hours,1 month,and 1 year after the operation.The cervical spine dysfunction index(NDI)was used to compare and statistically analyze the improvement of cervical spine function before operation,1 month and 1 year after operation,and the modified Odom’s grading method was used to evaluate the surgical efficacy of the two groups at 1 year after operation.At the same time,the risk points in PPECD surgery were summarized and the related risk control methods were discussed.Results: A total of 92 cases with complete follow-up was included,including60 cases in the PPECD group,34 males,26 females,with an average age of50.84±9.29 years old,32 cases in the ACDF group,17 males,and 15 females,with an average age of 51.37±10.19 years old.The VAS of preoperative neck and/or upper limb pain in the PPECD group was 8.45±1.46,the cervical spine dysfunction index(NDI)was 29.22±6.32,and the VAS of preoperative neck and(or)upper limb in the ACDF group was 8.46±1.52,and the cervical spine dysfunction index(NDI)was 30.59±6.14.There was no significant difference between the two groups(p>0.05),and they were comparable.The average operation time in the PPECD group was 150.38±28.02 minutes,the incision size was 1.21±0.18 cm,and the LOS was 2.05±0.87 days.The average operation time in the ACDF group was 70.66±11.31 minutes,the incision size was 5.27±0.55 cm,and the LOS was 5.31±1.87 days.There was a significant difference between the two groups(P<0.05).The VAS score of the incision pain in the PPECD group at 6 hours after surgery was 2.06±0.32,and the ACDF group at 6 hours after surgery was 3.06±0.54,which was significantly different between the two groups(P<0.05).The VAS of the PPECD group > 1month after operation improved to 1.05±0.39,and the ACDF group improved to1.21±0.48.There was no significant difference between the two groups(P>0.05).The VAS score of neck and/or upper limb pain was 2.51±0.47 in the PPECD group at 6 hours after surgery,and 3.79±0.83 in the ACDF group at 6hours after surgery.There was a significant difference between the two groups(P<0.05).VAS of the PPECD group improved to 1.24±0.38 at 1 month after surgery,0.42±0.05 at 1 year after surgery,and the ACDF group improved to1.56±0.51 at 1 month after surgery,and 0.31±0.09 at 1 year after surgery.There was no significant difference between the two groups(P>0.05).The NDI in the PPECD group was 14.87±4.89 one month after the operation,and the ACDF 18.78±5.56,which was statistically significant(P<0.05).The NDI index of the two groups was 10.46±2.75 and 11.90±2.86 at 3 months after operation,and 6.40±1.82 and 5.90±1 at1 year,and there was no significant difference(P>0.05).The surgical efficacy evaluation of the PPECD group(modified Odom’s grading method)was excellent in 49 people,good in 6 people,moderate in 4 people,and poor in 1,and the excellent and good rate was 91.7%.The ACDF group 23 excellent,7 good,1 fair,and 1 poor,and the excellent and good rate was 93.7%.There was no significant difference between the two groups(P>0.05).The surgical process was reviewed retrospectively.There were6 key points and risks of surgery such as puncture positioning,expansion and channel establishment,exposure of V point under microscope,establishment of Keyhole,exposure of nerve root and outer edge of dural sac,removal of nucleus pulposus,etc.The risk precautions of each operation step and the corresponding methods were discussed.No surgical complications such as dural sac tear,nerve root injury,vertebral artery injury,small joint instability caused by inaccurate opening occurred in all patients,and no surgical incision infection occurred.However,3 cases of ACDF had throat discomfort,which improved after symptomatic treatment.Conclusion: Compared with the anterior cervical decompression and fusion(ACDF),the percutaneous total endoscopic posterior cervical discectomy(PPECD)in the treatment of radiculopathy of cervical spondylosis is minimally invasive,safe,precise decompression,and faster in the postoperative recovery.At the same time,the operation has a higher learning curve,and requires practiced surgical skills and proficiency.During the operation,it is necessary to master the operation points of each operation step and achieve comprehensive surgical risk control.Complications can be controlled within the effective range. |
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