Anterior Cervical Discectomy And Fusion Combined With Posterior Percutaneous Endoscopic Cervical Discectomy For The Treatment Of "Pinching" Cervical Spondylotic Myelopathy

Objective:To investigate the efficacy of anterior cervical discectomy and fusion(ACDF)combined with posterior percutaneous endoscopic cervical discectomy(PPECD)for the treatment of “pinching” cervical spondylotic myelopathy.Methods : A retrospective analysis.Twenty-eight patients with “pinching” cervical spondylotic myelopathy who were admitted to the Third Hospital of Hebei Medical University in March 2015-May 2017 with the complete spinal surgery imaging and follow-up data were included.There were 15 males and 13 females.The age was 33～71(52.21±8.23)years old.15 patients who received anterior cervical decompression and fusion surgery were enrolled in the ACDF group.And 13 patients who received anterior cervical decompression and fusion combined with posterior percutaneous endoscopic cervical discectomy were enrolled in the Combined Surgery group.The patients were followed up for at least one year,the clinical and imaging indicators,such as the cervical visual analogue score(VAS),the Japanese Orthopaedic Association(JOA)score,axial symptoms,the cervical curvature(Cobb angle),ligamentum flavum area,spinal canal sagittal diameter,spinal canal area,spinal cord area and inter-vertebral height were compared between the two groups.Results:There were no statistically significant differences in the baseline data such as age(t=1.260),gender,duration of disease(t=0.812),preoperative NDI score(t=0.263)and diseased segment between the two groups(P >0.05).Compared with before surgery,there were significant differences in VAS and JOA scores between the two groups at different time points after surgery(P <0.01).There was no significant difference in Cobb angle between the Combined Surgery group and the ACDF group(10.85 ° ± 2.79 °,9.33 ° ± 3.48 °)(t =-1.255 P> 0.05)at 1 year after surgery.The differences in the ligamentum flavum area,spinal canal sagittal diameter,spinal canal area and spinal cord area at 1 year after surgery were statistically significant between the two groups(t=9.403、-2.855、-8.007、-2.447,P <0.05),and there were significant differences between the two groups before and after surgery(P <0.01)。There was no significant difference between the two groups in the inter-vertebral height at 1 year after surgery(t=-0.534 P>0.05),but there was a significant difference before and after surgery in the two groups(P<0.01).When the two groups of patients were followed up for 1 year,the number of patients with axial symptoms was counted and analyzed,it was found that there was no significant difference in the incidence of postoperative axial symptom between the two groups(P=0.705).Conclusions:(1)Combined surgery,compared with ACDF surgery,relieves the posterior compression,increases the effective volume of the spinal canal and more conducive to the recovery of spinal cord function after surgery.(2)The posterior percutaneous endoscopic cervical discectomy has less damage to the posterior cervical soft tissue.Compared with ACDF surgery,combined surgery does not increase the incidence of axial symptom.(3)Due to the implantation of internal fixation in combined surgery,it will not cause problems such as collapse of the inter-vertebral space caused by simple endoscopic surgery.