后路经皮脊柱内镜垂直锚定联合战壕技术治疗单节段中央型颈椎间盘突出症

Posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation

目的探讨后路经皮脊柱内镜垂直锚定联合战壕技术治疗单节段中央型颈椎间盘突出症的临床疗效。方法 2017年7月—2019年8月,采用后路经皮脊柱内镜垂直锚定联合战壕技术治疗13例单节段中央型颈椎间盘突出症患者。其中男6例,女7例;年龄43~64岁,平均50.5岁。病程3~17个月,平均9.2个月。其中,临床症状以颈痛伴上肢放射痛、麻木为主者5例,疼痛视觉模拟评分(VAS)为(6.60±0.55)分;以上肢乏力及行走不稳等脊髓损伤症状为主者8例,改良日本骨科协会(mJOA)评分为(12.75±0.71)分。记录手术并发症、手术时间及术中出血量,采用VAS评分及mJOA评分评估临床症状恢复情况。结果手术均顺利完成,无硬膜囊撕裂、脑脊液漏等严重并发症发生。手术时间83~164 min,平均101.2 min。术中出血量25~50 mL,平均33.1 mL。术后除1例失访外,其余12例患者获随访10~24个月,平均17.6个月。其中,术前以疼痛症状为主者VAS评分术后第1天(2.40±0.55)分、末次随访(1.80±0.45)分,较术前明显降低(P<0.05);术前以脊髓损伤症状为主者mJOA评分术后第1天(12.63±0.52)分、末次随访(14.29±0.95)分,其中末次随访时评分明显高于术前(P<0.05)。1例C4、5节段椎间盘突出且术前以脊髓损伤症状为主患者,术后手术部位血肿形成,出现急性四肢肌力减退,行经皮脊柱内镜下椎管内血肿清除及椎管减压术后恢复。结论经皮脊柱内镜垂直锚定联合战壕技术治疗单节段中央型颈椎间盘突出症安全、可行,可获得较好疗效。

Objective To investigate the clinical feasibility, safety, and effectiveness of posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation. Methods Between July 2017 and August 2019, 13 patients with the single-segmental central cervical disc herniation suffering from various neurologic deficits were treated with posterior percutaneous endoscopy via vertical anchor technique combined with trench technique. There were 6 males and 7 females with an average age of 50.5 years(range, 43-64 years). Disease duration ranged from 3 to 17 months(mean, 9.2 months). The clinical symptoms of 5 cases were mainly neck pain, radiculopathy, and numbness in upper limbs, and the visual analogue scale(VAS) score was6.60±0.55. The clinical symptoms of 8 cases were myelopathy including upper extremities numbness, weakness, and trouble walking, and the modified Japanese Orthopedic Association(mJOA) score was 12.75±0.71. The surgery-related complications, operation time, and intraoperative blood loss were recorded, and the results of clinical symptoms were measured by VAS scores and mJOA scores. Results All procedures were completed successfully, no severe complications such as dural tears or cerebrospinal fluid leakage occurred. The operation time ranged from 83 to 164 minutes(mean,101.2 minutes). The intraoperative blood loss was 25-50 mL(mean, 33.1 mL). After operation, 12 of 13 cases were followed up 10-24 months(mean, 17.6 months). The VAS scores of patients with preoperative pain symptoms were2.40±0.55 on the first day after operation and 1.80±0.45 at last follow-up, which were significantly lower than those before operation(P<0.05). The mJOA scores of patients with the symptoms of spinal cord injury were 12.63±0.52 on the first day after operation and 14.29±0.95 at last follow-up, and the score at last follow-up was significantly higher than that before operation(P<0.05). Acute extremities weakness occurred for the postoperative hematoma formation in 1 case(disc herniation at C4, 5) presented with myelopathy preoperatively, and muscle strength was recovered after the clearance of hematoma and spinal cord decompression under percutaneous endoscopy. Conclusion Posterior percutaneous endoscopy via vertical anchor technique and trench technique for single-segmental central cervical disc herniation was clinical feasible, safe, and effective, and could be an alternative approach to the treatment of central cervical disc herniation.