A Comparative Cohort Study Of Anterior Transcorporeal And Posterior Laminae Interval Space Of Full Endoscopic Cervical Discectomy For Paramedian Cervical Intervertebral Disc Herniation

Objective: To compare the clinical efficacy of PPECD and PEATCD for the treatment of paramedian cervical intervertebral disc herniation.and Explore the ideal minimally invasive surgery for the paramedian CIVDH,which provides a basis for clinical selection.Methods: Thirty-six cases of paramedian CIVDH admitted from November 2015 to March 2017 were reviewed.Nineteen cases were treated by PPECD,Seventeen cases were treated by PEATCD.Operation time,volume of removal disc and hospitalization time were compared beteeen the 2 groups.VAS scores,JOA scores were evaluated pre-and postoperation.Evaluation of cervical stability by radiography of flexion and extension positions before and after surgery was performed.Angular displacement and horizontal displacement were measured.Postoperative MRI evaluated the decompression of the spinal cord.Results: There was no significant difference between the two groups in gender and age(P>0.05).A total of 2 patients had surgery-related complications(one in each group).There was no significant difference between the two groups in the volume of removal disc(1.14±0.39 ml VS 1.26±0.46 ml,P>0.05)and hospitalization time(4.47±1.50 days VS 4.21±1.47 days,P>0.05).The operation time in PEATCD group was significantly longer than in PPECD group(117.35±23.12 min VS 99.95±19.46 min,P<0.05).There was no significant difference between the two groups in the preoperation VAS scores(7.47±0.94 VS 7.52±1.12,P>0.05)and JOA scores(12.23±1.52 VS 12.58±1.61,P>0.05).There was no significant comparing the difference of the last follow-up VAS scores minus the preoperative scores VAS in PEATCD with the difference of the last follow-up VAS scores minus the preoperative scores VAS in PPECD(6.35±1.46 VS 6.52±1.22,P>0.05).There was no significant comparing the difference of the last follow-up JOA scores minus the preoperative scores JOA in PEATCD with the difference of the last follow-up JOA scores minus the preoperative scores JOA in PPECD(3.53±1.12 VS 3.32±1.53,P>0.05).However,the last follow-up VAS score in PEATCD group and PPECD group was significantly lower than that before operation(1.12±0.78 VS 7.47±0.94;1.00±0.75 VS 7.52±1.12,P<0.05).The last follow-up JOA score in PEATCD group and PPECD group was significantly higher than that in preoperative group(15.82±0.88 VS 12.23±1.52;15.89±0.74 VS 12.58±1.61,P<0.05).There was no significant difference of between the two groups in the preoperation HD(1.77±0.52 mm VS 1.85±0.57 mm,P>0.05)and AD(6.91±1.95° VS 6.66±1.88°,P>0.05).There was no significant comparing the difference of the preoperation HD minus the postoperation HD in PEATCD with the difference of the preoperation HD minus the postoperation HD in PPECD(0.06±0.06 VS 0.07±0.05,P>0.05).There was no significant comparing the difference of the preoperation AD minus the postoperation AD in PEATCD with the difference of the preoperation AD minus the postoperation AD in PPECD(6.91±1.95° VS 6.66±1.88°,P>0.05).Conclusion: In this study,there was no difference in clinical efficacy between PEATCD and PPECD in the treatment of paramedian cervical intervertebral disc herniation,and there was no effect on the stability of cervical spine in a short period.However,PPECD is superior to PEATCD in terms of the operation time and uncontrollable surgical risks.More researches should be conducted to confirm it.