Clinical Efficacy Of Posterior Percutaneous Endoscopic Keyhole Surgery In The Treatment Of Single-segment Cervical Spondylotic Radiculopathy

ObjectiveTo compare the clinical efficacy of posterior cervical keyhole surgery and anterior cervical discectomy and fusion surgery in the treatment of single-segment CSR.MethodsThe clinical data of patients with cervical spondylotic radiculopathy admitted to our hospital for spinal surgery from January 2020 to January 2022 were retrospectively analyzed.According to the inclusion and exclusion criteria,a total of 42 patients who met the research criteria were screened out,and then divided into endoscopic group and open group according to different surgical methods.The endoscopic group included posterior cervical percutaneous endoscopic keyhole surgery(22 cases),and the open group included anterior cervical discectomy and fusion(20 cases).The general information of the two groups of patients,including surgical time,incision length,postoperative hospitalization time,hospitalization expenses,postoperative complications,and other conditions were compared.The neck and upper limb visual analog scale(VAS),the Japanese Orthopaedic Association(JOA)score,the Neck Disability Index(NDI),and the modified MacNab criteria were used to assess the clinical efficacy of the two groups of patients before surgery and at 1,3,6,and 12 months after surgery.ResultsAll 42 patients successfully underwent surgery,and there was no statistically significant difference in the general information of the two groups of patients(P>0.05).Compared with the open group,the endoscopic group had significantly shorter surgical time,smaller incisions,shorter postoperative hospitalization time,and lower hospitalization expenses(P<0.05).After surgery,the neck and upper limb VAS,JOA,and NDI scores of both groups of patients were significantly improved compared with those before surgery(P<0.05).The neck VAS score of the minimally invasive group was significantly lower than that of the open group at 1 month after surgery,and the difference was statistically significant(P<0.05).There were no statistically significant differences in the upper limb VAS,JOA,and NDI score between the two groups one month after surgery(P>0.05).There were no statistically significant differences in neck and upper limb VAS,cervical spine JOA,and NDI scores between the endoscopic group and the open group at 3,6 and 12 months after surgery(P>0.05).According to the modified MacNab criteria at the last follow-up,in the endoscopy group:17 cases were excellent,4 cases were good,1 case was fair,and 0 cases were poor,with an overall excellent and good rate of 95.5%;in the open group:17 cases were excellent,2 cases were good,1 case was fair,and 0 cases were poor,the overall excellent and good rate was 95%.There was no statistically significant difference between the two groups in the overall excellent and good rate(P>0.05).One patient in the endoscopic group experienced temporary sensory abnormalities in the upper limb after surgery,which disappeared after conservative treatment for 3 months.One patient in the open group experienced difficulty swallowing after surgery,which completely disappeared after 1 month.During the perioperative period and follow-up,no other complications such as dural tears,wound infections,and postoperative hematomas occurred in the two groups of patients,and no patients required revision surgery due to symptom recurrence,etc.ConclusionIn the short-term follow-up of single-segment cervical spondylotic radiculopathy,posterior cervical keyhole surgery and anterior cervical discectomy and fusion have similar clinical efficacy,but posterior cervical keyhole surgery has significant advantages in surgical time,trauma,hospitalization time,and hospitalization expenses,while avoiding cervical fusion and preserving the mobility of the cervical spine.We believe that under the premise of strict selection of indications,posterior cervical percutaneous endoscopic keyhole surgery is a safe,effective and minimally invasive surgical method,and it is an effective supplement to the traditional surgical treatment of single-segment cervical spondylosis,however longer follow-up is needed to further confirm these results.