显微内镜颈椎髓核摘除术治疗单节段神经根型颈椎病的临床疗效

Posterior cervical microendoscopic discectomy for monosegmental cervical spondylotic radiculopathy

目的探讨后路显微内镜颈椎髓核摘除术（cervical microendoscopic discectomy,CMED）治疗单节段神经根型颈椎病（cervical spondylotic radiculopathy,CSR）的临床疗效。方法 2010年9月至2013年3月,我科采用后路CMED治疗单节段CSR患者19例,18例获随访,其中男13例,女5例;年龄31~59岁,平均41.9岁;病变节段C（4~5） 5例,C（5~6） 9例,C6-7 4例;均表现为单侧神经根卡压节段性根性疼痛,颈椎动力位X线片未见颈椎不稳。首次随访时间6~25个月,平均12.7个月,末次随访28~51个月,平均32.5个月,随访观察患者的视觉模拟评分（visual analogue scale,VAS）、日本骨科学会（Japanese orthopaedic association,JOA）评分、颈椎病变节段稳定性和椎间高度的变化,并进行统计学分析。结果 VAS评分由术前的（7.12±1.11）分降至出院时的（2.82±0.64）分,首次和末次随访时分别为（1.94±0.76）分和（2.00±0.51）分;JOA评分由术前（12.58±1.06）分提高至出院时的（15.63±0.51）分,首次和末次随访时分别是（16.12±0.72）分和（15.88±0.78）分;出院时、首次随访和末次随访与术前相比,差异均有统计学意义（P〈0.05）;术前病变节段的椎间高度为（5.55±0.52）mm,末次随访时为（5.39±0.51）mm,虽有所减少,但差异无统计学意义（P〉0.05）;过伸过屈位X线片未显示明显颈椎失稳。结论只要选择好合适的适应证,后路CMED治疗单节段CSR创伤小、并发症少,能够获得满意的短中期临床疗效,但远期疗效仍有待继续观察。

Objective To describe the outcome of cervical microendoscopic discectomy （ CMED ） for monosegmental cervical spondylotic radiculopathy （ CSR ）. Methods A retrospective study was conducted on 19 patients with cervical spondylotic radiculopathy who underwent microendoscopic discectomy from September 2010 to March 2013, and 18 patients were followed up for 12.7 months （ range： 6 - 25 months ） at the first and 32.5 months （ range： 28 - 51 months ） at the end. There were 13 males and 5 females with an average age of 41.9 years （ range： 31 - 59 years ）. The level of herniation was C4.5 in 4 cases, C5.6 in 9 cases and C6.7 in 4 cases. All patients had clinical presentations and findings on neurological examinations consistent with unilateral herniated nucleus pulposus at singlelevel, while no dynamic instability were found in cervical hyperextension and hyperflexion on X-ray. Clinical efficacy were evaluated by VAS score, JOA score, the stability and intervertebral height in lesion segment. Results VAS decreased from （ 7.12 ± 1.11 ） points preoperatively to （ 2.82 ±0.64 ） points at discharge, to （ 1.94 ± 0.76 ） points at the first follow-up and to （ 2.00 ± 0.51 ） points at the final follow-up. JOA scores increased from （ 12.58± 1.06 ） points preoperatively to （ 15.63 ± 0.51 ） points at discharge, to （ 16.12 ± 0.72 ） points at the first follow-up and （ 15.88 ±0.78 ） points at the final follow-up. The preoperative VAS and JOA scores showed significant difference （ P 〈 0.05 ） as compared with those of each postoperative time point. Intervertebral height at surgical level of preoperative and at the final follow-up was （ 5.55±0.52 ）mm and （ 5.39 ± 0.51 ） mm respectively, which were not significantly different. （ P 〉 0.05 ）. No radiographic instability was revealed on dynamic radiographs. Conclusions With proper patient selection, posterior CEMD is safe and effective in treatment of single-level CSR with the advantage of minimal invasion and quick recovery, while its long-term outcomes require further follow-up.