Comparison Of Clinical Outcomes Between Posterior Cervical Foraminotomy And Anterior Cervical Discectomy With Fusion

Background It is common that some patients with cervical spondylotic radiculopathy(CSR).There are catholic treatments about it.The traditional measure of operation includes the anterior cervical discectomy with fusion(ACDF),posterior cervical microendoscopic discectomy(MED)and the posterior cervical foraminotomy(PCF),and so on.More and more patients request that which since the depth of minimally invasive known to us,On the basis of ensuring efficacy and safety,more and more scholars in domestic and foreign countries have using the technique of PCF.Objective This study is mainly used the technique of PCF and ACDF to treat the single segment of patients with CSR respectively,by using a reasonable observation and evaluation system to evaluate the operation outcome.With the analysis of retrospective clinical data and follow-up results,the surgical effect of the two operate measures also studies.Methods With the method of retrospective study,we collected 40 samples who diagnosed with single segment of CSR from January 2014 to December 2016 in the Affiliated Provincial Hospital of the Anhui Medical University.All the patients had the cervical vertebra anteroposterior,lateral,and dynamic cervical radiographs,the CT scan with 3D reconstruction and the cervical MRI before operation.There were 20 patients in PCF group and 20 patients in ACDF group.All patients have the data about one month,three months,six months and twelve months follow-up after operation.Comparison was made in terms of the lengths of skin incision,the operative time,blood loss-volume,the hospital stay after operation,the economic costs,and the neurological recovery.The mainly measures to evaluate the effect of operation are the visual analogue scale(VAS)and the neck disability index(NDI).The results of VAS and NDI were analyzed by SPSS19.0.The VAS and NDI score of pre-injury,post-injury,and follow-up were compared by group design of t-test,and P<0.05 set as significance.Result The mean lengths of skin incision in PCF group and ACDF group were(2.1±0.1)cm and(3.3±0.2)cm respectively which showed a significance difference;the operative time were(45±4.8)min and(43±3.9)min which had no significant significance;the bleeding volume were(74.5±13.6)ml and(75.3±11.8)ml which had no significant significance;the hospital stay were(1.2±0.4)and(2.8±0.4)days which showed a significance difference;the economic costs were(13955.15±294.32)and(35443.12±403.82)yuan which showed a significance difference.At the pre-operation,post-operation and the final follow-up,the results of VAS and NDI showed no significant difference between the two groups(P>0.05).There were one patient occurs hoarse voice and one patient had dysphagia after operation,all of which improved on the last follow-up.There were minority patients had appeared the numb symptom on the arm or hand after operation,which had relieved after symptomatic treatment.Conclusion Both PCF and ACDF can get a satisfying clinical-outcomes.The accurate localization of responsible focus from the microscope imaging with PCF which can get a minimally invasive,security,and a efficient results.However,PCF can reduce the complications compared with ACDF,also it had lesser trauma,more cost-effective,and retain the range of motion.Therefore,it is worthy to spreading around.