Clinical Efficacy of Posterior Percutaneous Endoscopic Unilateral Laminotomy with Bilateral Decompression for Symptomatic Cervical Spondylotic Myelopathy

Abstract

Objective To compare the clinical efficacy of posterior percutaneous endoscopic unilateral laminotomy (PPEUL) and anterior cervical decompression and fusion (ACDF) in the treatment of single‐segment spondylotic myelopathy (CSM). Methods This is a retrospective research, from January 2017 to December 2019, 30 cases were included in the PPEUL group and 32 cases were included in the ACDF group. The operative duration, blood loss, length of stay, complications, Japanese Orthopaedic Association (JOA) score, visual analogue scale (VAS) score, MacNab classification and imaging data were collected preoperatively, postoperative 1‐week, final follow‐up and statistically analyzed. Results The surgery was completed successfully on all patients, and there were no serious complications, such as nerve or spinal cord injury or infection. In the PPEUL and ACDF groups, the operative duration were 56.63 ± 1.40 and 65.21 ± 2.45 min, the intraoperative blood loss were 51.69 ± 3.23 and 50.51 ± 5.48 mL, and the hospitalization duration was 5.75 ± 1.43 and 6.38 ± 2.16 days. The follow‐up period in the PPEUL and ACDF groups was 24.96 ± 1.12 months and 25.65 ± 1.45 months, respectively. There was no significant difference in intraoperative blood loss between the two groups, but the hospitalization and operative durations in the PPEUL group were significantly shorter than those in the ACDF group (P < 0.05). The VAS scores at postoperative 1 week and final follow‐up were significantly improved compared with those before surgery. The JOA scores at postoperative 1 week and final follow‐up were significantly improved compared with those before surgery, but there was no significant difference between the two groups at the last follow‐up. The intervertebral disc height of the adjacent segment at the last follow‐up was significantly lower in the ACDF group than in the PPEUL group (P < 0.05), but there was no significant difference between the two groups in the intervertebral disc height of the surgical segment (P > 0.05). The rate of excellent and good results was 90.0% and 87.5%, respectively. Postoperative cervical CT and MRI showed that the spinal canal was fully decompressed and spinal cord compression was relieved. Conclusion PPEUL has the advantages of reduced trauma, rapid recovery and remarkable curative efficacy, so it is a new choice for the treatment of CSM.

Anterior Full‐endoscopic Single‐port Double Transcorporeal Spinal Cord Decompression for Noncontinuous Two‐segment Cervical Spondylotic Myelopathy: A Technical Note

“…Complications of cervical endoscopy vary depending on the choice of access and commonly include transient neurologic deficits, dural tears, visceral injuries, dysphagia, hematoma, and hoarseness 28–31 . In anterior cervical endoscopy, dysphagia is the most reported, while visceral injuries occur mainly in the esophagus 32,33 .…”

Clinical efficacy of posterior endoscopic cervical modified trench technique in the treatment of cervical spondylotic myelopathy: A retrospective study

“…Specifically, the other study found that at postoperative final follow-up, VAS scores were 1.57 ± 0.41, and JOA scores were 15.01 ± 1.32. [33] According to the results, the surgeries were completed smoothly without any serious complications such as arterial rupture, dural tear, cerebrospinal fluid leakage, or paralysis. However, one patient with a cervical disc herniation at C4/5 level experienced a decrease in strength in the right trapezius muscle after surgery (from grade 4 preoperatively to grade 3 postoperatively).…”

“…Specifically, the other study found that at postoperative final follow-up, VAS scores were 1.57 ± 0.41, and JOA scores were 15.01 ± 1.32. [33]…”

Comparative Study between Caspar Cervical Retractor System and Traditional S Retractor in Application on Anterior Cervical Decompression and Fixation

“…The vibration, compression and slight dislocation of the vertebral body will aggravate damage to the spinal cord, which can lead to serious consequences. 30 It is difficult for the assistant to maintain the traction force and position continuously when the traditional S‐hook is used to expose the incision of anterior cervical surgery. The operation inevitably causes vibration and even compression or traction of the spinal cord.…”