OBJECTIVE: To explore the clinical efficacy of posterior percutaneous endoscopic discectomy(PPECD) in the treatment of cervical spondylotic radiculopathy. METHODS: A total of 56 patiens with single segment cervical spondylotic radiculopathy from December 2017 to October 2020, were randomly divided into observation group and control group. In observation group, there were 16 males and 11 females, including 8 cases of C_4,5, 13 cases of C_5,6 and 6 cases of C_6,7 performed posterior percutaneous endoscopic discectomy, aged from 34 to 61 years old with an average of (51.15±6.29) years old. In control group, there were 19 males and 10 females with single segment cervical spondylotic radiculopathy including 10 cases of C_4,5, 14 cases of C_5,6 and 5 cases of C_6,7 performed anterior cervical discectomy and fusion, aged from 40 to 65 years old with an average of (53.24±5.31) years old. The operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were recorded. Visual analogue scale(VAS) and neck disability index(NDI) were used to evaluate the clinical efficacy. Cervical plain films or MRIs, CTs were taken for re-visiting patients. RESULTS: All patients were followed up more than 2 years. The observation group patients were followed up, the duration ranged from 24 to 42 months with an average of (30.48±4.91) months. The control group patients were followed up, the duration ranged from 25 to 47 months, with an average of (32.76±4.53) months. Compared with control group, operative time, intraoperative blood loss, postoperative time of lying in bed and length of postoperative hospital stay were decreased(P<0.05). Compared with pre-operation, VAS of neck and upper limb and NDI at the latest follow-up between two groups were significantly improved(P<0.05). Compared with control group, VAS of neck and upper limb at 1 day after operation in observation group were significantly reduced(P<0.05). There was no significant difference in VAS of neck and upper limb and NID at 1, 3 months and the latest follow-up after operation between two groups(P>0.05). In the observation group, one patient's deltoid muscle strength was weakened to grade 4 after operation, and returned to normal after 12 weeks of conservative treatment. In control group, there was 1 case of postoperative adjacent spondylosis with symptoms of spinal compression after 2 years operation, then underwent cervical artificial intervertebral disc replacement. And there was 1 case of dysphagia after operation in control group and improved after 1 year. There was no significant difference in incidence of complications between two groups. CONCLUSION PPECD has advantages of shortening operative time, decreasing intraoperative blood loss, reducing postoperative time of lying in bed and length of postoperative hospital stay. However, applicable age range of patients and long-term clinical efficacy needs further study.
Male ; Female ; Humans ; Adult ; Middle Aged ; Aged ; Radiculopathy/surgery* ; Cervical Vertebrae/surgery* ; Treatment Outcome ; Diskectomy ; Spondylosis/surgery* ; Blood Loss, Surgical ; Postoperative Hemorrhage ; Retrospective Studies ; Spinal Fusion

OBJECTIVE: To explore the clinical efficacy and safety of manual therapy combined with posterior percutaneous endoscopic cervical decompression(PECD) in the treatment of intractable cervical spondylotic radiculopathy. METHODS: From May 2016 to May 2018, 23 CSR patients who responded poorly to conservative treatment for at least 6 weeks underwent the combination management. Firstly, the patients received the posterior percutaneous endoscopic cervical decompression routine care for the following 4 weeks and manual therapy for another 4 weeks. A total of 23 patients were followed up, including 14 males and 9 females, the age ranged from 29 to 78 years old with an average of (50.30±12.28) years, the course of disease was 3 to 24 months with an average of (9.74±5.76) months. The lesion segment involved C_4,5 in 4 cases, C_5,6 in 13 cases, C_6,7 in 6 cases. The visual analogue scale (VAS), neck disability index (NDI), changes of cervical physiological curvature and interbody stability, adverse events were observed before and after operation. The follow-up time points were before operation, 1 day after operation and 1, 3 and 6 months after operation. RESULTS: All patients successfully completed the operation and manual treatment for 4 to 8 times. Among the 29 cases, 23 patients were followed up for more than 6 months. There was no spinal cord and nerve root injury during the treatment and follow-up. Operation time was from 80 to 120 min with a median of 90 min;intraoperative blood loss was from 35 to 80 ml with a median of 50 ml. NDI, VAS of neck, shoulder and arm each period after operation were significantly lower than those before PECD(P<0.05), while there were no significant improvement in cervical physiological curvature and target segment intervertebral space height(P>0.05);there was no significant change in interbody stability (P>0.05). After received the manual therapy, NDI significantly decreased (P<0.05), however, there was no significant difference in VAS of neck, shoulder and arm, physiological curvature of cervical spine and intervertebral space height of target segment compared with that before manual treatment (P>0.05);there was no significant change in interbody stability (P>0.05). CONCLUSION Manual therapy combined with PECD in the treatment of intractable cervical spondylotic radiculopathy can not only quickly improve the symptoms, but also alleviate the residual symptoms after PECD safely and effectively, and can not cause obvious signs of accelerated instability of cervical adjacent segments in the short term.
Cervical Vertebrae/surgery* ; Child ; Child, Preschool ; Decompression/adverse effects* ; Female ; Humans ; Male ; Musculoskeletal Manipulations ; Radiculopathy/surgery* ; Retrospective Studies ; Spondylosis/surgery* ; Treatment Outcome

OBJECTIVE: To explore the short-term clinical efficacy of single-stage cervical spondylotic radiculopathy (CSR) between the minimally invasive Key-hole technique and anterior cervical Zero profile intervertebral fusion system (Zero-P). METHODS: A retrospective analysis was performed on 45 patients who underwent surgical treatment for CSR from January 2017 to January 2020, including 21 in Key hole group (12 males and 9 females), followed up for 10-22(13.2±2.3) months;24 cases in Zero-P group (14 males and 10 females), and the follow up period was 10 to 23(12.7±1.9) months. Perioperative conditions (incision length, intraoperative blood loss, operation time, length of hospital stay, and complications) were compared between two groups, and X-rays of cervical spine before and after surgery and at the final follow-up were taken to analyzed curvature of the cervical spine, visual analogue scale(VAS) of pain before and after surgery, Oswestry Disability Index(ODI) and Japanese Orthopaedic Association (JOA) score of cervical spine were recorded to evaluate clinical efficacy. RESULTS: In Key-hole group and Zero-P group, the surgical incision length, intraoperative blood loss, operation time, final follow-up Cobb angle and immediate postoperative VAS score respectively were (1.2±0.2) cm, (5.3±0.3) cm;(35.3±9.7) ml, (120.2±13.5) ml;(56.4±11.3) min, (90.6±12.6) min;(3.2±3.9)°, (7.3±3.8)°;(2.8±1.2)points, (3.8±1.1) points;the Zero-P group was larger than the Key hole group, with statistical significance( CONCLUSION The cervical spine Key-hole technology is similar to the anterior cervical Zero-P system in the treatment of CSR. The Key-hole technique has certain advantages in incision length, intraoperative blood loss, and operation time. It is a safe, effective and can be widely used cervical spine surgery method.
Case-Control Studies ; Cervical Vertebrae/surgery* ; Female ; Humans ; Male ; Radiculopathy/surgery* ; Retrospective Studies ; Spinal Fusion ; Spondylosis/surgery* ; Treatment Outcome

OBJECTIVETo explore the early clinical effect and safety of percutaneous transforaminal endoscopic technology for cervical spondylotic radiculopathy.

METHODSFrom August 2016 to September 2017, 14 patients with cervical spondylotic radiculopathy who responded poorly to non-surgical treatment for at least 6 weeks underwent percutaneous transforaminal endoscopic discectomy via posterior approach. There were 6 males and 8 females, aging from 32 to 68 years old with an average of (40.5±7.6) years. The course of disease ranged from 0.5 to 13.0 months with an average of (6.0±1.33) months. The lesions involved C₄,₅ in 2 cases, C₅,₆ in 8 cases, C₆,₇ in 4 cases. Visual analogue scale (VAS), Japanese Orthopedic Association (JOA), Short Form 36 health survey questionnaire(SF-36) were recorded preoperatively and during the latest follow-up to evaluate the clinical outcome. Horizontal displacement and angular displacement of vertebral body were measured by cervical dynamic X-rays.

RESULTSAll operations were successful. No spinal cord injury, nerve root or vascular injuries were found. Operation time was from 60 to 100 min with a median of 75 min;intraoperative bleeding was from 30 to 80 ml with a median of 40 ml. All patients were followed up for 2 to 13 months with a median of 9 months. During the follow-up period, the patients with neck and shoulder pain were significantly relieved without recurrence. No nucleus pulposus protrusion was found in the primary surgical segment, and there was no obvious sign of degeneration in the adjacent vertebral body. At the latest follow-up, VAS, JOA and SF-36 scores were obviously improved(<0.05). There was no significant difference in horizontal displacement and angular displacement of vertebral body before and after the operation (>0.05). The cervical curvature at the latest follow-up was higher than preoperative findings (<0.05). And there was no significant difference in intervertebral disc height preoperatively and postoperatively(>0.05).

CONCLUSIONSPercutaneous transforaminal endoscopic discectomy in treating cervical spondylotic radiculopathy can effectively and safely relieve neck and shoulder pain, improving nerve function, enhance life quality, maintaining cervical stability. It is worthwhile to generalize and apply in clinical settings.

Adult ; Aged ; Cervical Vertebrae ; pathology ; Diskectomy, Percutaneous ; Endoscopy ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; surgery ; Spondylosis ; surgery ; Treatment Outcome

Epidural neuroplasty is a treatment modality for back pain and/or radiating pain caused by mechanical compression or neural inflammation of intra-spinal neural structures. Since epidural neuroplasty was first introduced as a treatment for pain caused by epidural adhesion such as failed back surgery syndrome (FBSS), it has been performed as a treatment for many kinds of pain of spinal origin including acute/chronic herniation of intervertebral disc, radiculopathy, spinal stenosis, FBSS, epidural adhesion, vertebral compression fracture, vertebral metastasis, resistant multilevel degenerative arthritis, epidural scar pain by infection or meningitis, and whiplash injury. Epidural neuroplasty is a catheterization technique used to treat back pain and/or radiating pain by injecting therapeutic drugs into lesions of epidural space shown as a filling defect in epidurogram. Usually, normal saline, local anesthetics, and steroid are used as therapeutic drugs. The exact mechanisms of action of the procedure are unknown but include 2 postulated mechanisms of action for pain relief. i.e., mechanical adhesiolysis by volume effect and chemical adhesiolysis by injected drugs. Relative large volumes of normal saline injection resolve adhesions and wash out accumulated pain substances; local anesthetics are used for stabilization and analgesia of flaring neural structures and for pain management for procedure related pain; and steroid is used for the treatment of inflammation of neural and peri-neural structures. The resolution of filling defect can be verified by post-procedure epidurogram. The key point of epidural neuroplasty for good results, is the exact localization of the epidural catheter into the epidural lesion.
Analgesia ; Anesthetics, Local ; Back Pain ; Catheterization ; Catheters ; Cicatrix ; Epidural Space ; Failed Back Surgery Syndrome ; Fractures, Compression ; Inflammation ; Intervertebral Disc ; Intervertebral Disc Displacement ; Meningitis ; Neoplasm Metastasis ; Osteoarthritis ; Pain Management ; Radiculopathy ; Spinal Stenosis ; Whiplash Injuries

Delphi Technique ; Humans ; Radiculopathy ; drug therapy ; surgery ; therapy

As our population ages and the rate of spine surgery continues to rise, the use epidural lysis of adhesions (LOA) has emerged as a popular treatment to treat spinal stenosis and failed back surgery syndrome. There is moderate evidence that percutaneous LOA is more effective than conventional ESI for both failed back surgery syndrome, spinal stenosis, and lumbar radiculopathy. For cervical HNP, cervical stenosis and mechanical pain not associated with nerve root involvement, the evidence is anecdotal. The benefits of LOA stem from a combination of factors to include the high volumes administered and the use of hypertonic saline. Hyaluronidase has been shown in most, but not all studies to improve treatment outcomes. Although infrequent, complications are more likely to occur after epidural LOA than after conventional epidural steroid injections.
Constriction, Pathologic ; Failed Back Surgery Syndrome ; Hyaluronoglucosaminidase ; Loa ; Radiculopathy ; Spinal Stenosis ; Spine

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.
Back Pain ; Congenital Abnormalities ; Constriction, Pathologic ; Decompression ; Failed Back Surgery Syndrome ; Humans ; Lumbar Vertebrae ; Osteoarthritis ; Radiculopathy ; Spinal Fusion ; Spinal Stenosis* ; Spine ; Spondylolysis

Lumbar spinal stenosis (LSS) is mostly caused by osteoarthritis (spondylosis). Clinically, the symptoms of patients with LSS can be categorized into two groups; regional (low back pain, stiffness, and so on) or radicular (spinal stenosis mainly presenting as neurogenic claudication). Both of these symptoms usually improve with appropriate conservative treatment, but in refractory cases, surgical intervention is occasionally indicated. In the patients who primarily complain of radiculopathy with an underlying biomechanically stable spine, a decompression surgery alone using a less invasive technique may be sufficient. Preoperatively, with the presence of indicators such as failed back surgery syndrome (revision surgery), degenerative instability, considerable essential deformity, symptomatic spondylolysis, refractory degenerative disc disease, and adjacent segment disease, lumbar fusion is probably recommended. Intraoperatively, in cases with extensive decompression associated with a wide disc space or insufficient bone stock, fusion is preferred. Instrumentation improves the fusion rate, but it is not necessarily associated with improved recovery rate and better functional outcome.
Back Pain ; Congenital Abnormalities ; Constriction, Pathologic ; Decompression ; Failed Back Surgery Syndrome ; Humans ; Lumbar Vertebrae ; Osteoarthritis ; Radiculopathy ; Spinal Fusion ; Spinal Stenosis* ; Spine ; Spondylolysis

OBJECTIVETo analyze the clinical and radiologic outcomes of bilateral uncovertebral joints resection and decompression in treating cervical spondylotic radiculopathy through anterior approach.

METHODSFrom January 2007 to December 2009, the clinical data of 56 patients with cervical spondylotic radiculopathy undergoing sugical treatment were retrospectively analyzed. There were 33 males and 23 females with an average age of (58.83 +/- 8.01) years (ranged 41 to 72). The course was from 5 to 48 months with an average of (14.09 +/- 8.54) months. All patients underwent bilateral uncovertebral joints resection, vertebral canal decompression and fusion through anterior approach. Perioperative, radiologic,nerve functional parameters were analyzed before and after operation. Perioperative parameters included hospital stay days and blood loss volume and operative time; radiologic parameters included vertebral height and lordosis angle and fusion rate; and according to JOA score to evaluate the nerve function.

RESULTSAll patients were followed up from 12 to 30 months with an average of 18.2 months. Hospital stay days, blood loss volume and operative time were (4.42 +/- 0.25) d, (195.51 +/- 23.67) ml and (145.52 +/- 28.29) min, respectively. Preoperative vertebral height was (5.19 +/- 0.03) cm, and postoperative 1 year arrived to (5.37 +/- 0.29) cm, there was no significant difference between preoperative and postoperative (P > 0.05). Lordosis angle increased from preoperative (1.53 +/- 0.03) degrees to (7.78 +/- 0.66) degrees at the 1 year after operation (P<0.01). Fusion rate was 96.5% at the 1 year after operation. JOA score increased from preoperative 8.69 +/- 2.13 to 15.58 +/- 2.45 at the 1 year after operation (P < 0.001). According to standard of JOA scoring, 20 cases were excellent, 28 good, 7 fair and 1 poor.

CONCLUSIONUncovertebral joints resection and decompression through anterior cervical approach in treating cervical spondylotic radiculopathy is safe and reliable, which can get satisfactory clinical outcomes. This surgical procedure is suitabl oe for the patients of cervical spondylosis, especially combined canal stenosis and osteophytosis of the uncovertebral joint.

Adult ; Aged ; Cervical Vertebrae ; surgery ; Decompression, Surgical ; methods ; Female ; Humans ; Male ; Middle Aged ; Radiculopathy ; etiology ; surgery ; Spinal Fusion ; methods ; Spondylosis ; surgery