颈前路内镜联合后路单开门治疗多节段椎管狭窄伴巨大椎间盘突出的临床分析

Clinical analysis of APECD and ODLP in the treatment of multisegmental cervical stenosis and giant disc herniation

目的探讨颈前路经皮内镜椎间盘切除术(APECD)联合后路单开门椎管扩大成形术(ODLP)治疗多节段椎管狭窄伴巨大椎间盘突出的临床疗效。方法 2016年9—11月收治的多节段椎管狭窄伴巨大椎间盘突出患者3例,男2例、女1例,年龄56~61岁。3例患者均有明显肌力或感觉异常,手术治疗先行ODLP使脊髓后移,然后行APECD。术前和术后分别进行疼痛视觉模拟评分(VAS)评估颈部和上肢疼痛情况,颈椎功能障碍指数(NDI)评分评价神经功能改善情况。结果本组患者术后2周疼痛程度和神经功能均较术前明显改善,术中未发生颈髓损伤或血管损伤,术后无切口感染、血肿形成、脑脊液漏、吞咽困难、声音嘶哑等并发症。结论多节段椎管狭窄伴巨大椎间盘突出实施APECD联合ODLP治疗,能够安全地进行神经减压并改善症状。APECD能保留椎间盘和运动节段,虽然不能预防椎间盘退变,但有利于延缓邻近节段的退变,因此具有一定的临床意义。

Objective To investigate the effect of anterior percutaneous endoscopic discectomy(APECD)and opendoorlaminoplasty(ODLP)through hybrid surgery in the treatment of multisegmental cervical stenosis and giant discherniation.Methods This study involved3patients with multisegmental cervical stenosis and giant disc herniationconfirmed by MRI.Among them,there were2males and1female,with ages from56-61.All patients showed significantparesthesia or weakness,and were treated between September and November2016.The surgery was performed by first theODLP that made spinal cord back shift,and then APECD for the second step.The visual analog scale(VAS)and neckdisability index(NDI)were assessed before and after operation.Results The VAS and NDI scores were improved twoweeks after operation.No adverse events like spinal cord injury and vascular injury were found during the operation.Afteroperation,no patients were found incision infection,hematoma formation,cerebrospinal fluid leakage,dysphagia,trachyphonia and so on.Conclusion The hybrid surgery of APECD and ODLP for the treatment of the multisegmentalcervical stenosis and giant disc herniation can not only decompress the nerve safely and improve the function,but alsopreserve cervical intervertebral disc and motion segments,therefore delaying the degeneration of adjacent segments withclinical significance.