The efficacy of microscope-assisted anterior cervical discectomy and fusion with cervical spondylosis for 37 cases
10.3760/cma.j.issn.1001-2036.2019.03.008
- VernacularTitle:显微镜辅助经前路颈椎间盘切除融合术治疗颈椎病37例
- Author:
Jing WANG
1
;
Jiang DU
;
Yaozhong LIANG
;
Chenhuan LU
;
Kairui ZHU
;
Miweng JIANG
;
Huihuan YU
Author Information
1. 暨南大学附属第一医院骨科
- Keywords:
Cervical spondylosis;
Approach anterior,cervical discectomy and fusion;
Microsurgical technique
- From:
Chinese Journal of Microsurgery
2019;42(3):241-245
- CountryChina
- Language:Chinese
-
Abstract:
Objective To explore the efficacy and safety of anterior cervical discectomy and fusion assisted with microscope.Methods Thirty-seven patients with cervical spondylosis were included to be retrospectively ana lyzed,including 21 males and 16 females.All these patients had accepted anterior cervical discectomy and fusion (ACDF) assisted with microscope from October,2015 to February,2018,and they were aged from 22 to 77 years old (51.5±6.2 years on the average).In these patients,30 cases were operated on single segment,6 cases were operated on double segments,and 1 case was operated on 3 segments.Among all the patients,15 patients of which (40.54％) had cervical spondylotic myelopathy and 22 patients of which (59.46％) sufferered from cervical spondylotic radicu lopathy.All the operations were performed with a conventional transverse anterior cervical incisions,an intervertebral distractor was placed.The decompression was completed under the microscope,and the fixation was performed under direct vision.Moreover,the operative time,intraoperative blood loss and surgery-related complications were recorded.Follow-up was carried out at different times,including 7 days,1 month,3 months,6 months and every year after operation.Japanese Orthopaedic Association (JOA) score was used to calculate the rate of improvement in neurological function,which can evaluate the clinical efficacy.And cervical dysfunction index (NDI) was used to assess cervical function.Results All patients in this group underwent successful decompression under the microscope.The operation time was 90-160 min,with an average of (110.67±36.42) min;The intraoperative blood loss was 20-110 ml,with an average of (36.00±29.11) ml.All patients were followed-up for 12-31 months,with an average of (15.2±4.7) months.The JOA score improved from 8.37±3.26 preoperatively to 15.96 ± 1.50 at the last follow-up,and its difference had signifi cance in statistics (t=8.592,P=0.000).Neurological function improvement rate could be graded:excellent in 31 cases and good in 6 cases,the excellent and good rate was 100％;NDI was reduced from 19.01 ± 6.47 preoperatively to 5.81 ± 2.58 at the last follow-up,with statistical significant difference (t=5.127,P=0.000).During the follow-up,1 screw was found loosened and slightly withdrawn in 1 female patient at 3 months after operation,of whom had not obvious discomfort.The patient was continuously observed and there was no screw withdrawal again.Moreover,there were no complications such as cerebrospinal fluid leakage,hoarseness and difficulty in swallowing.Conclusion Microscope-assisted ACDF can provide safe and adequate decompression without significantly extending the operation time,which is satisfactory in clinical results.Even in some cases of 1 or 2 segments of intervertebral disc nucleus prolapse,it is possible to avoid a more traumatic ACDF.And it is worthy of clinical promotion.
