经皮颈椎后路内镜下椎间盘切除术治疗单节段合并椎管内骨化颈椎病

目的:探讨经皮颈椎后路内镜下椎间盘切除术治疗单节段合并椎管内骨化颈椎病患者的安全性及有效性。方法:2017年8月至2019年7月采用经皮颈椎后路内镜下椎间盘切除术治疗单节段颈椎病合并椎管内骨化的患者23例,其中男16例,女7例;年龄29~74(50±13)岁;病程3~120个月,中位数6个月;神经根型颈椎病9例,脊髓型颈椎病6例,混合型颈椎病8例。按骨化性质分:椎体后缘骨赘17例,突出物骨化3例,后纵韧带骨化3例。按骨化物在椎管内的位置分:中外侧型14例,中央型5例,混合型4例。手术均采用后路经皮颈椎内镜下颈椎间盘切除术(posterior percutaneous endoscopic cervical discectomy,PPECD),由同一名医师完成。比较手术前后疼痛视觉模拟评分(visual analogue scale,VAS)和日本骨科协会(Japanese Orthopaedic Association,JOA)评分;术后3个月根据改良Macnab标准评定临床疗效。结果:23例患者手术均顺利完成。手术时间30~155(69.1±27.2)min,术后卧床时间2~3(3.0±0.9)h,术后住院时间2~7(4.1±1.5)d。术后3 d颈椎CT三维重建示骨化组织完全清除者13例,术后残留者10例,残留位于上位椎体后缘及(或)中央。出院时VAS评分较术前显著降低(t=9.35,P<0.001),其中评分为0~3者有21例。术后JOA评分较术前显著提高(t=7.29,P<0.001)。术后3个月根据改良Macnab标准评价疗效,结果优18例,良4例,可1例,优良率95.6%(22/23)。结论:对于具备足够内镜经验的医生而言,经皮颈椎后路内镜下椎间盘切除术治疗单节段合并椎管内骨化颈椎病患者是安全可靠的,并可获得良好的临床效果。

Clinical efficacy of posterior percutaneous endoscopic cervical discectomy for single level cervical spondylopathy with intraspinal ossification

Objective: To evaluate the effectiveness and security of posterior percutaneous endoscopic cervical discectomy (PPECD) in the treatment of single level cervical spondylopathy with intraspinal ossification.Methods: Twenty three patients with single level cervical spondylopathy with intraspinal ossification were treated by posterior percutaneous endoscopic cervical discectomy between August 2017 and July 2019. There were 16 males and 7 females,aged from 29 to 74 years old with an av- erage of (50±13) years.The disease duration were 3 to 120 months with a median of 6 months. There were 9 cases of cervical spondylotic radiculopathy,6 cases of cervical spondylotic myelopathy,and 8 cases of mixed cervical spondylopathy. According to the characteristics of ossification,17 cases were osteophytes on the posterior edge of the vertebral body;3 cases were protru- sion ossification;3 cases were posterior longitudinal ligament ossification. According to the position of ossification in spinal canal,14 cases were medial and lateral type,5 cases were central type,and 4 cases were mixed type. Posterior percutaneous cervical endoscopic cervical discectomy in patients performed by the same surgeon. Japanese Orthopaedic Association (JOA) score and visual analogue scale(VAS) were compared separately before and after operation. At 3 months after operation,clini- cal effect was assessed according to modified Macnab standard.Results: All operations were successful. The operative time was 30 to 155 (69.1±27.2) min. The bedridden time was 2 to 3(3.0±0.9) h,length of postoperative hospitalization was 2 to 7(4.1±1.5) d. Three dimensional CT reconstruction of the cervical spine at 3 days after operation showed that ossified tissue of 13 cases were completely removed,and 10 cases were left after operation,and the residual was located at the posterior edge and/or center of the upper vertebral body. VAS score at discharge from hospital was significantly lower than that before operation (t=9.35,P<0.001),and 21 cases had a score of 0 to 3. Postoperative JOA score was significantly higher (t=7.29,P<0.001). At 3 months after operation,according to modified Macnab standard to evaluate clinical effect,18 cases got exellent results,4 good and 1 fair,with an excellent and good rate of 95.6%(22/23).Conclusion: For an experienced surgeon,percutaneous posterior cervical endoscopic discectomy is safe and reliable in treating single level cervical spondylopathy with intraspinal ossification, and can obtain good clinical results.