A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and/or lateral spinal stenosis: a clinical retrospective study

Abstract

Background: Percutaneous endoscopic cervical decompression (PECD) is an ideal minimally invasive decompression technique for the treatment of cervical spondylotic radiculopathy (CSR). However, the mainstream is the resection of dorsal bone and removal of free nucleus pulposus. The necessity of excision of ventral osteophytes and hyperplastic ligaments in the treatment of CSR caused by cervical foraminal and/or lateral spinal stenosis (CFa/oLSS) to be discussed.

Methods: We performed a retrospective study of 46 patients with CSR caused by CFa/oLSS from January 2017 to November 2018. These patients received posterior percutaneous endoscopic cervical decompression-ventral bony decompression (PPECD-VBD)(23 cases, classified as VBD group) or posterior percutaneous endoscopic cervical decompression-simple dorsal decompression (PPECD-SDD)(23 cases, classified as SDD group). Following surgery, we recorded Visual Analogue Scale (VAS), Neck Disable Index (NDI), Japanese Orthopaedic Association (JOA) Scores and myodynamia. We further evaluated the changes of cervical curvature and cervical spine motion in the VBD group and recorded the operation time and complications during the follow-up of each patient.

Results: All patients underwent successful operations, with an average follow-up time of 16.53 ± 9.90 months. The excellent and good rates in the VBD and SDD groups were 91.29 and 60.87%, respectively. In the SDD group, neck-VAS, arm-VAS, and NDI scores were significantly higher than those of the VBD group at 1 day, 6 months, and 12 months after surgery (P < 0.05), while the JOA scores and improvement rate of JOA were significantly lower than those of the VBD group (P < 0.05). There were no significant differences in terms of angular displacement (AD), horizontal displacement (HD), segmental angle (SA) and cervical curvature (CA) before and after the operation in the VBD group (P > 0.05).

Conclusion: PPECD-VBD was significantly better than PPECD-SDD as well as PPECD-VBD had no significant effects on cervical spine stability or cervical curvature.

Keywords: Cervical foraminal and/or lateral spinal stenosis (CFa/oLSS); Cervical spondylotic radiculopathy (CSR); Minimally invasive surgery; Percutaneous endoscopic cervical decompression (PECD); Posterior percutan-eous cervical endoscopic decompression-ventral bony decompression (PPECD-VBD); Posterior percutaneous cervical endoscopic decompression-simple dorsal decompression (PPECD-SDD).

Fig. 1

Surgical procedure.a Surgeon during operation.b The position of the working sleeve.c Removal of ventral osteophytes. Both d and e Spinal cord is represented by yellow and black circle, respectively. Vertebral edge with ventral osteophytes removed is represented by yellow triangle, ventral pressure substances is represented by black triangle, nerve root is represented by black diamond

Fig. 2

Radiological evaluation. a The cervical curvature (CA) is measured using the tangential method from C2 to C7. The segmental angle (SA) is measured the angle between the superior endplate to the inferior endplate of the cephalic and caudal vertebra using Cobb’s method. b the ratio of facet joint grinding is calculated as 100% × (G - g)/G

Fig. 3

Clinical score in following up. a arm-VAS. b neck-VAS. c NDI score. d JOA score

Fig. 4

Preoperative and postoperative radiological characteristics of PPECD-VBD. a Preoperative CT sagittal image.b Postoperative CT sagittal image. c Preoperative CT axial image of the surgical segment. d Postperative CT axial image of the surgical segment. e Preoperative MRI axial image of the surgical segment. f Postperative MRI axial image of the surgical segment

Fig. 5

Model diagram for PPECD-VBD