Endoscopy-assisted anterior cervical discectomy and fusion with internal fixation vs conventional surgery in the treatment of cervical disc herniation

Abstract

Introduction: Cervical disc herniation (CDH) is a common condition, usually caused by excessive strain or trauma to the spine. Initially, it is treated conservatively; however, complex and resistant cases may require a surgical intervention. Aim: We aimed to compare the clinical effect of endoscopy-assisted anterior cervical discectomy and fusion (ACDF) with internal fixation and conventional surgery in the treatment of CDH. Materials and methods: Patients with CDH who underwent ACDF with fixation at the Zhoushan Dinghai Guanghua Hospital were enrolled. Of them, 10 individuals were treated with conventional ACDF (conventional surgery group), and the other 10 with endoscopy-assisted ACDF (endoscopy-assisted surgery group). The general characteristics, postoperative Japanese Orthopedic Association (JOA), visual analogue scale (VAS), 12-Item Short Form Survey Physical Component Summary (SF-12 PCS), and SF-12 Mental Component Summary (SF-12 MCS) scores, physiological stress response, rate of the improved JOA score (RIS), hemoglobin level, and bone graft fusion were compared between the groups. Results: Outcomes of the patients treated with endoscopy-assisted surgery were clearly superior to those observed in the conventional surgery group. The postoperative JOA, VAS, SF-12 PCS, and SF-12 MCS scores and RIS in the endoscopy-assisted surgery group were higher than in the conventional surgery group (P <⁠0.05). Following operation, there were significant differences between the 2 groups with respect to RIS at 1 week and 6 months postsurgery and hemoglobin levels on postoperative day 2. Changes in heart rate and diastolic blood pressure in the endoscopy-assisted surgery group were less pronounced than in the conventional surgery group (P <⁠0.05), and the fusion rate was significantly higher in the former group (90% vs 80%, respectively). Conclusions: Endoscopy-assisted ACDF with internal fixation has a greater clinical therapeutic effect than the conventional approach in the treatment of CDH. It is associated with a higher bone graft fusion rate and reduced intraoperative blood loss.

Keywords

• anterior cervical spine operation
• cervical disc herniation
• cervical vertebra
• endoscope
• fusion