Effective And Safe Range Of Percutaneous Posterior Full-endoscopic Paramedian As Well As Lateral Cervical Discectomy And Its Relationship With The Indications Selection

Objective: To preliminary study the effective and safe range of paramedian and lateral cervical discectomy by percutaneous posterior full-endoscopic,at the same time provide reference for its indications selection.Methods: 10 patients with paramedian and lateral cervical disc herniation who were diagnosed in Affiliated Hospital of Zunyi Medical College had been chosen from august 2015 to november 2015.All patients who hadn’t contraindications underwent percutaneous posterior full-endoscopic cervical discectomy.Recording postoperative complications,respectively in the preoperative and postoperative 1 day, 1 month, 3 months using VAS score assessment of patients with neck shoulder pain relief, joa17 score standard evaluation of neurological function recovery.Clinical efficacy was evaluated according to the modified Mac Nab criteria for 3 months after operation.According to the preoperative and postoperative MRI of the cervical spine,vertical distances between border of dural sac and medial border of disc herniation,vertical distances between border of dural sac and medial border of discectomy,vertical distances between border of dural sac and median sagittal line were measured.Results: All the patients had successful operation, no complications such as spinal cord injury and dural rupture occurred, operation incision healed. Neck and shoulder pain VAS score:preoperation were 8.10±0.88, 1 day after the operation were 3.20±0.42,1 month after the operation were 1.40±0.52,3 months after the operation were 1.20±0.42, 1 days, 1 month and 3 months after operation neck pain VAS score compared with preoperative, the difference was statistically significant(P < 0.05) and after operation each time point VAS rating gradually reduced. Joa score:preoperative were 8.90±0.74, 1 day after the operation were 13.20±0.42,1 month after the operation were 14.50±0.53,3 months after the operation were 14.80±0.42,1 days, 1 and 3 months after operation JOA score compared with preoperative, the difference was statistically significant(P < 0.05) and postoperative JOA score at each time point gradually increased. According to the modified macnab criteria,3 months after operation for the evaluation of curative effect, 8 cases were excellent, good in 2 cases, the excellent rate of 100%.Preoperative and postoperative cervical MRI were measured in all patients, preoperative vertical distance between border of dural sac and medial border of disc herniation was 6.6-9.0mm,with an average of 8.00±0.78 mm,postoperative vertical distance between border of dural sac and medial border of discectomy was 4.2-6.5mm,with an average of 5.49±0.69 mm,preoperative vertical distances between border of dural sac and median sagittal line was 9.0-10.2,with an average of 9.71±0.41 mm.The ratio of postoperative vertical distance between border of dural sac and medial border of discectomy to preoperative vertical distances between border of dural sac and median sagittal line was 43.75-64.36%,with an average of 55.60±6.17%.Conclusion: Percutaneous posterior full-endoscopic cervical discectomy is a safe and effective treatment technology deal with paramedian as well as lateral cervical herniation,which can cut cervical disc protruding from the medial of dural.When vertical distance between medial border of disc herniation and border of dural sac within 5.49±0.69 mm,the ratio of postoperative vertical distance between border of dural sac and medial border of discectomy to preoperative vertical distances between border of dural sac and median sagittal line was 55.60±6.17%, applicating the technology can achieve effective and safe resection.