Posterior Percutaneous Endoscopic Cervical Discectomy for Single-Segment Cervical Spondylotic Radiculopathy: A Retrospective Study with Minimum 3-Year Follow-Up

Abstract

Background: Posterior percutaneous endoscopic cervical discectomy (P-PECD) has been increasingly used for cervical spondylotic radiculopathy (CSR), while few studies have reported on its medium-long-term outcomes. This study aims to investigate the medium-long-term efficacy and imaging findings of P-PECD in the treatment of single-segment CSR.

Methods: The data of 51 patients with single-segment CSR treated with P-PECD were retrospectively analyzed. Efficacy was evaluated using visual analog scale (VAS) scores of neck and arm, Japanese Orthopaedic Association (JOA) score, neck disability index (NDI), and modified Macnab criteria. Radiologic parameters were measured before and after the operation, including cervical Cobb angle, range of motion (ROM), intervertebral space height, as well as horizontal and angular displacement at the operative level.

Results: The VAS scores of neck and arm, JOA score, and NDI were significantly improved postoperatively compared with those before the operation, and the differences were statistically significant (P <0.05). Based on the modified Macnab criteria at the final follow-up, 94.12% showed excellent to good outcomes. Postoperatively, the cervical Cobb angle was 10.63 ± 1.79^°, ROM was 6.33 ± 1.11^°, the intervertebral space height was 4.63 ± 0.85 mm, horizontal and angular displacement at the operative level were 0.88 ± 0.68 mm and 4.25 ± 1.04^°, respectively, and there were no significantly changed at the final follow-up.

Conclusion: P-PECD for single-segment CSR has the advantages of less trauma, less bleeding, a low complication rate, faster postoperative recovery, and less impact on cervical mobility and stability, which has excellent medium-long-term efficacy.

Keywords: cervical spondylotic radiculopathy; discectomy; minimally invasive; percutaneous endoscopic.

Figure 1

A 44-year-old female with CSR (C5/6) underwent P-PECD. (a–e). Preoperative imaging studies. (a and b) showed cervical kyphosis, without cervical instability. (c) showed hyperostosis at the posterior margin of the vertebral body. (d and e) showed cervical disc herniation, located in the right foramen region. (f) showed intraoperative fluoroscopy. (g) endoscopic image of the dura and traversing nerve root. (h) a photo of the nucleus pulposus and bone were removed. (i) was CT image two days after the operation, and the range of fenestration was satisfactory. (j and k) showed the nucleus pulposus in the right foramen area was completely removed. (l and m) showed there was no recurrence 3 years after the operation.