Clinical Application Of Key-hole Lateral Mass Decompression And Discectomy Under Posterior Total Spinal Endoscopy In Cervical Spondylotic Radiculopathy

Objective Comparison of the clinical efficacy of Key-hole lateral mass decompression and discectomy under minimally invasive posterior total spine endoscopy and open anterior cervical discectomy and fusion(ACDF)in the treatment of single-segment cervical spondylotic radiculopathy(CSR).Methods A retrospective analysis of the clinical data of 40 patients with single-segment cervical spondylosis(CRS)in our department from September 2018 to December 2019,including 23 males and 17 females,aged 32-76 years.According to different surgical methods,20 patients who underwent anterior cervical discectomy and fusion(ACDF)were the open group,and 20 patients who underwent posterior total spine endoscopic Key-hole side mass decompression and discectomy were the endoscopic group.Compare the baseline data of the two groups of patients,as well as the operation time,blood loss,incision length,hospitalization time,hospitalization costs,postoperative complications,etc.;regular follow-up,compare the two groups of patients before and after 1,3,6,12 at the month and last follow-up,the visual analogue scale for neck and upper limb pain(VAS),cervical spine dysfunction index(NDI),and Odom criteria were used to evaluate the clinical efficacy at the last follow-up.Results There was no statistically significant difference in baseline information between the two groups of patients(both P values> 0.01).Compared with the open group,the endoscopic group had shorter operation time,less bleeding,smaller incision,shorter hospital stay,and lower cost.The differences were statistically significant(t=3.451,15.844,49.438,6.772,28.311,P values all <0.01).Postoperative follow-up was 12 to 24 months.Complications occurred in 1 case in the open group and 2 cases in the endoscopy group.The VAS of the open group and the endoscopy group were(2.90±0.42)and(2.11±0.29)points respectively,and the NDI scores were(21.75±3.85)and(17.60±2.04)points,respectively.The differences were statistically significant.(t=6.966,4.260,all P values <0.01);there was no statistically significant difference in the VAS and NDI scores between the groups before and 3,6,and 12 months after the operation and at the last follow-up(all P values> 0.05)).In the last follow-up,the clinical efficacy was evaluated according to Odom criteria.In the endoscopic group,14 cases were excellent and 4 cases were good.In the open group,15 cases were excellent and 3 cases were good.There was no significant difference in the excellent and good rate between the two groups(Z =-0.311,P> 0.05).Conclusions Both types of operation obtained satisfactory clinical efficacy in the treatment of single-level cervical spondylotic radiculopathy.However,minimally invasive keyhole lateral mass decompression and discectomy under posterior total spinal endoscopy with local anesthesia demonstrated the advantages of lessened trauma,quickened recovery,lessened cost,and high security,hence worthy of further promotion and application in clinics.