| OBJECTIVE: 1.Clarify the effectiveness of total endoscopic transvertebral cervical discectomy for the treatment of cervical disc herniation.2.To explore a new method for measuring the size of cervical disc herniation suitable for clinical application.3.To analyze whether transendoscopic cervical discectomy can completely remove the prominent nucleus pulposus tissue to achieve full decompressionMethods: Twenty-three patients who underwent total endoscopic cervical discectomy from January 2016 to April 2018 were included in our department,including 13 males and10 females;the symptoms were involved in 4 cases in spinal cord,7 cases in radiculopathy,and 12 cases of mixed symptoms;5 cases of C4 / 5 segment,10 cases of C5/6 segment,and 8cases of C6/7 segment;the average age of patients was 54.00 ± 12.24 years,and the average duration of symptoms was 12.56 ± 9.93 weeks.All patients were measured for the depth of the nucleus pulposus into the spinal canal,the width of the nucleus pulposus,and the height of the nucleus pulposus using magnetic resonance imaging(MRI)images before surgery to assess the size of the protruding disc;Computed Tomography(CT)images were used to measure the extent of decompression under endoscopy in the next week,and the MRI was reviewed to evaluate whether the disc removal was complete.Before the surgery and 1 day,1 week,1 month,3 months,6 months,and 1year after the surgery,the patient's Visual Analog Scale(VAS)was recorded to assess the pain;before the surgery and 1 day,1 week,1 month,3 months,6 months,and 1 year after the surgery,Japanese Orthopaedic Association Scores(JOA)was recorded to assess neurological function.In the last Followup,the modified macnab criteria was used to assess theefficacy.Results: Twenty-three patients successfully completed the operation by the same surgeon,and none of them were changed to open surgery.No obvious complications occurred.A review of MRI showed that the prominent nucleus pulposus tissue was completely removed,and the dural sac and nerve root were fully decompressed.The VAS scores before the surgery and 1 day,1 week,1 month,3 months,6 months,and 1 year after the surgery were:6.24±2.08,3.43±1.58,2.26±1.18,1.63±0.91,1.05±0.78,0.65±0.57,0.63 ± 0.64;before the surgery and 1 day,1 week,1 month,3 months,6 months,and 1 year after the surgery,the JOA scores were:8.07±2.15,10.22±1.99,12.43±1.52,13.78±1.10,14.65 ± 0.92,15.15 ± 0.87,15.65 ± 1.08.Postoperative VAS scores and JOA scores were significantly higher at follow-up time than that before the surgery(P <0.05).Improved Macnab criteria at the last follow-up: 14 cases were excellent,8 were good,1 was fair,and the excellent and good rate was 95.7%;Before the surgery,the depth of the discherniation into the spinal canal was 5.04±0.79 mm,the height of the herniateddisc was 9.49±1.61 mm mm,and the width of the herniated disc was 10.55±2.09 mm.After the surgery,the width and the height of the decompression range under the endoscope are 10.96±1.91 mm and10.43±1.60 mm respectively.Conclusion: Anterior total endoscopic transvertebral cervical discectomy is safe and feasible.When the cervical disc herniation width is within 10.96±1.91 mm and the herniation height is within 10.43±1.60 mm,a sufficient field of vision can be obtained under the endoscope and effective decompression can beachieved. |
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