CT引导下后外侧入路脊柱内镜治疗神经根型颈椎病的疗效分析

Analysis of curative effect of CT-guided posterolateral approach spinal endoscopy for cervical spondylotic radiculopathy

摘要:

目的 探索CT引导下后外侧入路脊柱内镜治疗神经根型颈椎病（CSR）的安全性和有效性。方法 纳入2019年9月－2020年12月该院收治的CSR患者17例，在局部麻醉CT引导下，结合环锯锚定完成后外侧入路脊柱内镜手术，记录患者的年龄、性别、病程、手术节段和术中并发症等。于术前、术后3 d和术后6个月应用疼痛视觉模拟评分法（VAS）评估患者疼痛情况；在术前和术后6个月用颈椎功能障碍指数量表（NDI）评估患者颈椎功能恢复情况；在术后6个月采用改良MacNab分级法评估患者的临床预后。结果 17例患者均顺利完成手术，术后3 d和术后6个月VAS分别为2.00（2.00，3.00）和1.00（0.00，1.00）分，明显低于术前的6.00（6.00，7.00）分（P < 0.05）；术后6个月NDI为4.44（2.22，10.00）%，明显低于术前40.00（32.50，46.00）%（P < 0.05）。用改良MacNab分级法评估患者优良率为88.2%。17例患者术中和术后均无严重并发症发生。结论 CT引导下后外侧入路脊柱内镜手术是治疗CSR的一种可行的微创手术方式，可减轻患者疼痛，改善生活质量，有进一步探讨的价值。

Abstract:

Objective To explore the safety and efficacy of CT-guided posterolateral approach spinal endoscopy for the treatment of cervical spondylotic radiculopathy (CSR).Methods From September 2019 to December 2020, 17 patients with CSR performed posterolateral endoscopic spinal surgery under local anesthesia guided by CT combined with ring saw anchoring. The patients' age, gender, course of the disease, surgical segment, and intraoperative complications were recorded. The visual analogue scale (VAS) was used to assess pain before surgery, 3 days after surgery, and 6 months after surgery. The preoperative and postoperative cervical disability index (NDI) was used to assess functional recovery. Clinical outcomes were assessed by modified MacNab grading at 6 months postoperatively.Results The operation was completed successfully in 17 patients, The VAS of 17 patients at 3 days and 6 months after surgery were 2.00 (2.00, 3.00) and 1.00 (0.00, 1.00), significantly lower than 6.00 (6.00, 7.00) before surgery (P < 0.05). NDI at 6 months after surgery was 4.44 (2.22, 10.00)%, significantly lower than 40.00 (32.50, 46.00)% before surgery (P < 0.05). The excellent and good efficacy rates in modified MacNab grading was 88.2%. None of the 17 patients had serious complications during or after the operation.Conclusion CT-guided posterolateral spinal endoscopy is a feasible minimally invasive surgical approach for the treatment of CSR, which significantly improves the quality of life, and is worthy of further discussion.