Analysis On Short-term Curative Effects Of Anterior Transvertebral Full-endoscopic Approach In The Treatment Of Central And Paracentral Cervical Intervertebral Disc Herniation

Objective:To analyze the short-term curative effects of ATVF in the treatment of central and paracentral cervical intervertebral disc herniation.Methods: A total of 12 patients accepted ATVF to treat cervical intervertebral disc herniation in our hospital between November 2015 and February 2016. Among the patients, 5 patients were male while 7 patients were female, aging from 38 to 73 years old, 54.92±10.19 on average. Compressed spinal segments included C3/C4 in 1 case, C4/C5 in 5 cases and C5/C6 in 6 cases. The symptoms lasted for 5-18 month, 10.42±3.70 on average. Postoperative follow-up was from 3 to 6 months, 4.17±0.94 months on average.The operation time, intraoperative bleeding, intraoperative removal of nucleus pulposus, postoperative off-bed activity time and surgery-related complications were recorded. Observation indexes on clinical curative effects included improvement of spinal compression through cervical MRI in postoperative 1 week and 3 months, and JOA scores as well as shoulder and cervical VAS pain scores before operation, in postoperative 1 week and 3 months. Intervertebral space height changes of surgical segments and cervical stability were observed through imaging examination included CT+3D reconstruction, cervical AP and lateral position, hyperextension and hyperflexion positions before operation, in postoperative 1 week and 3 months.Results: The operation time was 95-244 min, with an average of 131.83±42.19 min.Intraoperative bleeding was too little to be neglected.Intraoperative tissue removal amount was 0.5- 1.0 ml, 0.79±0.16 ml on average. There were no related complications after operation. With relieve of cervical spinal compression was found in cervical MRI in postoperative 1 week and 3 months. JOA scores: 7.45±2.07 before operation, 13.90±1.30 in postoperative 1 week, and 15.27±1.90 in postoperative 3 weeks; there were statisticallysignificant differences of postoperative 1 week and postoperative 3months, compared with preoperative values(P<0.05). Shoulder and cervical VAS pain scores: 3.42±1.98 before operation, 1.25±1.06 in postoperative 1 week, and 0.58±0.67 in postoperative 3 months; there were statistically significant differences of postoperative 1 week and postoperative 3 months, compared with preoperative values(P<0.05). Intervertebral disc height:4.19±0.89 mm before operation, 3.80±0.96 mm in postoperative 1 week, and 3.59±0.90 mm in postoperative 3 months; there were no statistically significant differences of postoperative 1 week and postoperative 3 months, compared with preoperative values(P>0.05). Cervical instability was not found in cervical images at AP, lateral, hyperextension and hyperflexion positions in postoperative 1 week and 3 months.Conclusion: Full-thickness endoscopy via anteriorvertebralapproach is effective and reliable in the treatment of central and paracentral cervical intervertebral disc herniation, with smaller trauma, less bleeding and shorter recovery time. Intervertebral disc height of diseased vertebra was not obviously decreased after operation, and there was no cervical instability. There were no related complications after operation. Full-thickness endoscopy via anteriorvertebralapproach is an effective and safe endoscopy method for central and paracentral cervical intervertebral disc herniation.