경추부 추간판 탈출 환자에 대하여 전방유합술과 내시경 후방 추간판 제거술의 수술적 결과

Abstract

Background and Objectives : Minimal invasive lumbar discectomy (MID) such as Percutaneous endoscopic cervical discectomy (PECD) have promoted as an alternative to conventional discectomy. The PECD may be less injury to muscle, decreased postoperative pain, and faster recovery time. Percutaneous endoscopic cervical discectomy (PECD) is an effective minimally invasivesurgery for soft cervical disc herniation in properly selected cases. The current gold standard is anterior cervical discectomy and fusion (ACDF). However, few studies have evaluated the outcome of PECD compared with ACDF. In this study, we report on the clinical efficacy and safety of posterior PECD in patients diagnosed with degenerative cervical radiculopathy.

Materials and Methods : We performed retrospective controlled randomized study from January 2017 to December 2019. We compared the surgical results of PECD and ACDF. Data from patients treated with single-level PECD (n = 32) or ACDF (n = 32) were analyzed. Patients were prospectively entered into the clinical database and their records were retrospectively reviewed. Perioperative data and clinical outcomes were evaluated using the visual analogue scale (VAS), NeckDisability Index (NDI), and modified Macnab criteria. VAS and NDI results significantly improved in both groups. Inclusion criteria were disc herniation at the one single level, regardless of side. The relationship of several factor(Age, sex, operation technique, operation level) and recurrent rate were evaluated.

Results : Age, sex, and operation level were not statistically significant difference about recurrent rate. Especially operation technique such as endoscopic discectomy or microscopic open discectomy were not statistically significant difference for recurrent rate. Perioperative data and clinical outcomes were evaluated using the visual analogue scale (VAS), Neck isability Index (NDI), and modified Macnab criteria. VAS and NDI results significantly improved n both groups. The rates of excellent or good results were 90.62%,93.75% in the PECD and ACDF group, respectively. The revision rates were 3.92% and 1.56% in the PECD and ACDF group, respectively. Operative time, hospital stay, and time to return to work were reduced in the PECD group compared to the ACDF group (p < 0.001).

Conclusion : These parameters that we checked are all no statistically significant difference. And recurrent rate are not related with one side of operation technique. The cause of postoperative recurrence has been unknown.

Key words : Cervical disc herniation; Percutaneous endoscopic cervical Ddiscectomy (PECD)