Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report
Percutaneous full-endoscopic anterior transcorporeal cervical discectomy and channel repair: a technique note report
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经皮全内镜前路经皮颈椎间盘切除术及通道修复术：技术说明报告
DOI：
10.1186/s12891-019-2659-0
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发表时间：
2019-06-10
影响因子：
2.3
通讯作者：
Liao, Wen-Bo
中科院分区：
文献类型：
--
作者：
Du, Qian;Lei, Lan-Qiong;Liao, Wen-Bo
研究背景与颈前路椎间盘切除融合术（ACDF）相比，颈前路经皮质疝切开术（ATH）保留了颈椎活动节段和椎间盘。但传统的ATH由于通道狭窄，限制了手术视野和操作。经皮全内窥镜经椎间盘颈椎间盘切除术是一种微创的功能性脊柱手术。然而，椎间盘高度的显著损失是不可避免的。本研究的目的是说明经皮全内镜下经皮前路经皮质颈椎间盘切除术（PEATCD）和通道修复术（CR）治疗颈椎间盘突出症（CDH）的可行性，安全性和有效性，并介绍我们的手术经验。术后记录视觉模拟评分（VAS）、日本骨科协会（乔亚）和改良Macnab标准。术后1周和3个月分别行CT检查，观察切口愈合情况。不需要引流管。未发生手术相关并发症。与术前评估相比，术后VAS和乔亚评分均有所改善。根据改良Macnab标准，3例患者的临床疗效为优，1例患者的临床疗效为良。根据术后MRI，所有患者的疝均被完全切除。在术后期间，未观察到修复实施的移位和钻孔椎骨的塌陷。在术后3个月获得的CT图像上几乎没有骨通道。ConclusionThis是第一次在内窥镜下同时进行前路经皮质颈椎间盘切除术和CR。该方法对椎间盘损伤小，保留了颈椎活动节段。这是一种可行、安全、微创的手术。 ChiCTR 1800016383 . 2018年5月29日注册已登记的逆行。试验注册：中国临床试验注册中心。
BackgroundCompared to anterior cervical discectomy and fusion (ACDF), cervical motion segment and disc was retained through anterior transcorporeal herniotomy (ATH). But surgical field and manipulation in traditional ATH was restricted by the narrow channel. Percutaneous full-endoscopic transdiscal cervical discectomy is a minimally invasive and functional spine surgery. However, significant loss of intervertebral disc height was inevitable. This study was done to illustrate the feasibility, safety, and efficacy and present our surgical experience of percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) and channel repair (CR) for the treatment of cervical disc herniation (CDH).MethodsFour patients with CDH were chosen to undergo PEATCD and CR with a follow-up care for at least 22 months. The visual analogue score (VAS), Japanese Orthopedic Association (JOA), and modified Macnab criteria were recorded during the postoperative periods. CT images were obtained to observe the healing of the channel at 1 week and 3 months after the operation.ResultsThe average operating time was 83.75 min. Drainage tubes were unnecessary. No procedure-related complications occurred. The postoperative VAS and JOA scores were improved compared to those of the preoperative assessment. The clinical efficacy was excellent in 3 patients and good in 1 patient at final follow up stage according to the modified Macnab criteria. The hernia was removed completely in all patients according to postoperative MRI. Migration of the repair implementation and collapse of the drilled vertebrae were not observed during the postoperative periods. The bony channel was nearly absent on CT images obtained at 3 months postoperative.ConclusionThis is the first time that the anterior transcorporeal cervical discectomy and CR have been performed simultaneously under endoscopy. Less damage to disc and the retained cervical motion segment were achieved through this method. This is a feasible, safe, and minimally invasive procedure.Trial registrationNumbers: ChiCTR1800016383 . Registered 29 may 2018. Retrospectively registered. Trial registry: Chinese Clinical Trial Registry.