脊髓型颈椎病内镜下前路椎间盘切除融合术

Endoscopic Anterior Discectomy and Fusion for Cervical Spondylotic Myelopathy

摘要:

［目的］介绍内镜辅助下前路颈椎间盘切除融合术（Endoscope-Anterior Cervical Discectomy and Fusion，Endo-ACDF）的手术技术和初步临床结果。［方法］2021年01月～2023年02月，对15例脊髓型颈椎病患者采用Endo-ACDF治疗。内镜下切除突入椎管内的椎间盘组织、椎体骨赘、后纵韧带，确定硬膜前方完全减压无压迫，硬膜搏动恢复，用撑开器械将椎间隙撑开，将融合器植入椎间隙。［结果］所有患者顺利完成手术，术中无严重并发症。术后随访6～12个月，相较于术前，术后轴性疼痛VAS评分及NDI评分明显降低（P<0.001），颈椎JOA 评分显著升高（P<0.001）。术后复查颈椎影像，颈椎内固定及椎间盘术后在位，硬脊膜及神经根解压彻底。［结论］Endo-ACDF治疗脊髓型颈椎病，具有清晰的可视化手术视野，是一种精准、安全可靠且能够实现充分减压的手术方式，短期疗效满意。

Abstract:

[Objective] This paper describes the surgical techniques and preliminary clinical results of Endoscope-Anterior Cervical Discectomy and Fusion (Endo-ACDF).[Methods] From January 2021 to February 2023,15 patients with cervical myelopathy were treated with Endo-ACDF. The intervertebral disc tissue, vertebral osteophytes and posterior longitudinal ligament protruding into the spinal canal were removed endoscopically to determine that the anterior dural membrane was completely reduced without compression, and the dural beat was restored. The vertebral space was extended with the open device, and the cage was implanted into the vertebral space.[Results] All patients completed the procedure successfully without serious intraoperative complications. During the postoperative follow-up of 6 to 12 months, the postoperative VAS score of axial pain and NDI score were significantly lower (P <0.001), and the cervical JOA score was significantly higher (P <0.001). After surgery, cervical imaging was reviewed, cervical internal fixation and disc surgery, and the dural and nerve roots were completely decompression.[Conclusion] Endo-ACDF provides the treatment of cervical myelopathy with clear visual surgical vision, and is an accurate, safe and reliable surgical method that can achieve sufficient decompression, with satisfactory short-term efficacy.