CT引导脊柱内镜后外侧入路腹侧减压术治疗脊髓型颈椎病

CT-guided posterolateral full-endoscopic ventral decompression for single-level cervical spondylotic myelopathy

目的:探讨CT引导脊柱内镜后外侧入路腹侧减压术(posterolateral full-endoscopic ventral decompression,PLEVD)治疗脊髓型颈椎病(cervical spondylotic myelopathy,CSM)的有效性和安全性。方法:选取2018年5月至2020年3月临床确诊单节段CSM病人31例,行CT引导下PLEVD手术,测量术中工作通道与矢状位角度,以及术前、术后椎管最小矢状径,观察术前、术后1天、7天、1月、3月、6月、12月及末次随访时视觉模拟评分法(visual analogue scale,VAS)评分和颈椎日本骨科学会(Japanese orthopaedic association,JOA)评分,JOA恢复率评估脊髓损伤恢复效果,记录手术并发症。结果:术后各观察期VAS评分、JOA评分、椎管最小矢状径均较术前明显改善(P<0.01);末次随访JOA恢复率示:优17例、良11例、可3例,优良率90.3%。结论:经初步探讨,CT引导下脊柱内镜后外侧入路腹侧减压术治疗单节段脊髓型颈椎病安全、有效,值得进一步研究。

Objective:To evaluate the safety,feasibility and efficacy of posterolateral full-endoscopic ventral decompression(PLEVD)guided by computed tomography(CT)in patients with cervical spondylotic myelopathy(CSM).Methods:From May 2018 to March 2020,31 patients with single-level CSM underwent CT-guided PLEVD.The work-channel posterolateral angle was measured according to CT images during surgery,and the minimum sagittal diameter of spinal canal(MSDC)was measured according to CT images before and after surgery.The pain intensity of cervical or limbs was evaluated with visual analog scale(VAS).The Japanese orthopedic association(JOA)score and recovery rate were applied to assess the neurological condition.Moreover,the surgery related complications were also been documented.Results:Compared with pre-operation,the VAS score was significantly decreased at post-operation,and the JOA score was significantly improved after surgery compared with that before surgery(P<0.01).The JOA recovery rate in the final shows that 17/31 cases achieved excellent,11/31 in good and 3/31 in fair.The excellent or good rate is 90.3%.Conclusion:Our preliminary research suggests that CT-guide PLEVD is a safe and effective technique for treatment of single-level CSM,which is worthy of further study.