经Delta通道椎间孔镜治疗神经根型颈椎病

目的:探讨经Delta通道椎间孔镜治疗神经根型颈椎病的早期临床疗效及安全性。方法:对2017年9月至2018年7月收治的10例神经根型颈椎病患者行经Delta通道后路椎间孔镜下椎间盘摘除术,其中男6例,女4例;年龄30～62(41.5±4.3)岁;均为单侧根性症状,其中C_(4,5) 2例,C_(5,6) 5例,C_(6,7) 3例。所有患者CT及MRI检查提示无后纵韧带骨化及黄韧带钙化等影像学表现,颈椎动力位X线片无颈椎不稳,经系统非手术治疗6周以上,疗效欠佳。观察患者术前及末次随访时颈肩痛VAS评分、JOA评分、NDI评分、颈椎生理曲度、颈椎病变节段椎间高度和稳定性的改变。结果:所有手术顺利完成,无脊髓、神经根或大血管损伤情况的发生。手术时间70～120 min,平均90 min;术中出血量30～90 ml,平均40 ml。10例患者均获得随访,时间6～14个月,平均9个月。所有患者术后神经根性疼痛缓解满意,神经功能有所改善。VAS评分由术前的7.15±2.01降至末次随访时的1.59±0.83;JOA评分由术前的12.57±1.24升至末次随访时的16.42±0.58;NDI评分由术前的41.82±4.71提高到末次随访时的9.59±3.52;末次随访与术前比较差异均有统计学意义(P0.05)。颈椎生理曲度D值由术前的(8.21±0.84) mm升至末次随访时的(10.89±0.96) mm (P0.05)。病变节段椎间高度术前、末次随访时分别为(5.62±0.59)、(5.60±0.57) mm,差异无统计学意义(P0.05)。末次随访时颈椎动力位X线片未见颈椎失稳。结论:经Delta通道后路椎间孔镜下椎间盘摘除术治疗神经根型颈椎病能取得较为满意的疗效,且不影响颈椎的稳定性,安全性可靠,值得临床应用。

Treatment of cervical spodylotic radiculopathy with posterior intervertebral foraminal discectomy via Delta channel

Objective: To explore the clinical efficacy and safety of posterior intervertebral foraminal discectomy via Delta channel for cervical spondylotic radiculopathy in the early phase.Methods: From September 2017 to July 2018,10 patients with cervical spondylotic radiculopathy underwent posterior intervertebral foraminal discectomy via Delta channel. There were 6 males and 4 females,aged from 30 to 62 years old with an average of (41.5±4.3) years old. All of them had unilateral symptoms caused by cervical nerve root compression,including 2 cases of C_4,5,5 cases of C_5,6 and 3 cases of C_6,7. CT and MRI examination of all the patients did not show ossification of posterior longitudinal ligament or calcification of ligamentum flavum,and no cervical spine instability was present in dynamic radiographs. The clinical outcome was poor after more than 6 weeks of systematic non-surgical treatment. The VAS score,JOA score,NDI score,the cervical spine physiological curvature,and the height and stability of the compressed cervical vertebrae were measured before operation and at the latest follow-up.Results: All patients successfully completed the surgeries without any spinal cord,nerve root or major blood vessel injury. The operation time was 70 to 120 min with an average of 90 min. Intraoperative blood loss ranged from 30 to 90 ml with an average of 40 ml. All the 10 patients were followed up for 6 to 14 months with an average of 9 months. Postoperative nerve root pain got relievd and nerve function was improved in all patients. VAS score decreased from 7.15±2.01 before surgery to 1.59±0.83 at the latest follow-up;JOA score increased from 12.57±1.24 before surgery to 16.42±0.58 at the latest follow-up;NDI score increased from 41.82±4.71 before surgery to 9.59±3.52 at the latest follow-up. All the results above presented significant difference between latest follow-up and preoperative(P<0.05). The D value of cervical physiological curvature increased from (8.21±0.84) mm before surgery to(10.89±0.96) mm at the latest follow-up,and the difference was also statistically significant(P<0.05). The height of the diseased vertebrae was(5.62±0.59) mm before surgery and (5.60±0.57) mm at the latest follow-up,with no statistically significant difference(P>0.05). At the latest follow-up,no cervical instability was observed on dynamic radiographs.Conclusion: Treatment of cervical spondylotic radiculopathy by posterior intervertebral foraminal discectomy via Delta channel can obtain a satisfactory clinical outcome without affecting the stability of cervical vertebra. The surgery is safe,reliable and worthy of clinical application.