Clinical efficacy and learning curve of percutaneous endoscopic cervical discectomy for symptomatic cervical spondylotic radiculopathy.

This study aimed to evaluate the clinical efficacy and learning curve of percutaneous endoscopic cervical discectomy (PECD) in treating patients with symptomatic cervical spondylotic radiculopathy (CSR). A total of 105 patients with single-segment symptomatic CSR treated between January 2020 and January 2022 were retrospectively analyzed and divided into PECD and ACDF groups based on the surgical approach. Patient demographics, operation time, estimated intraoperative blood loss, complications, postoperative hospital stay, total hospitalization cost, neck dysfunction index (NDI), arm and neck visual analog scale (VAS) scores were compared and analyzed. The learning curve of the PECD group was assessed using cumulative sum (CUSUM) analysis. There was no statistically significant difference in baseline data between the two groups (P > 0.05). The PECD group had shorter operative time, smaller incision length, less estimated intraoperative bleeding, lower total hospitalization costs, and shorter postoperative hospital stays compared to the ACDF group (P < 0.05). Postoperative NDI, arm VAS, and neck VAS scores improved significantly in both groups compared to preoperative values (P < 0.05). However, no significant difference was found between the two groups during the same period (P > 0.05). There were also no significant differences between the PECD and ACDF groups in the number of intraoperative fluoroscopies, complications, or surgical success rates (P > 0.05). As more cases accumulated, a trend toward shorter operative times was observed in the PECD group. When grouped according to the learning curve, with the 23rd case as the cutoff point, there was no significant difference in clinical outcomes between the learning phase and proficient phase groups (P > 0.05). PECD is a safe and effective procedure for treating single-segment CSR, offering clinical outcomes comparable to ACDF. PECD has a notable learning curve, requiring beginners to perform 23 cases to reach proficiency. However, longer operative times do not negatively impact preclinical outcomes. Retrospectively registered.

Sun X ，Zhan L ，Tang Z ，Shen M ，Ma H ，Tan J ... -  《Journal of Orthopaedic Surgery and Research》

Unilateral biportal endoscopic decompression versus anterior cervical decompression and fusion for unilateral cervical radiculopathy or coexisting cervical myelopathy: a prospective, randomized, controlled, noninferiority trial.

Cervical spondylosis (CS), including myelopathy and radiculopathy, is the most common degenerative cervical spine disease. This study aims to evaluate the clinical outcomes of unilateral biportal endoscopy (UBE) compared to those of conventional anterior cervical decompression and fusion (ACDF) for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. A prospective, randomized, controlled, noninferiority trial was conducted. The sample consisted of 131 patients who underwent UBE or ACDF was conducted between September 2021 and September 2022. Patients with cervical nerve roots or coexisting spinal cord compression symptoms and imaging-defined unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs were randomized into two groups: a UBE group (n = 63) and an ACDF group (n = 68). The operative time, blood loss, length of hospital stay after surgery, and perioperative complications were recorded. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) scale scores, visual analog scale (VAS) scores, neck disability index (NDI) scores, and recovery rate (RR) of the mJOA were utilized to evaluate clinical outcomes. The hospital stay after surgery was significantly shorter in patients treated with UBE than in those treated with ACDF (p < 0.05). There were no significant differences in the neck or arm VAS score, NDI score, mJOA score, or mean RR of the mJOA between the two groups (p < 0.05). Only mild complications were observed in both groups, with no significant difference (p = 0.30). UBE can significantly relieve pain and disability without severe complications, and most patients are satisfied with this technique. Consequently, this procedure can be used safely and effectively as an alternative to ACDF for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. This study was registered in the Chinese Clinical Trial Registry on 02/08/2023 ( http://www.chictr.org.cn , #ChiCTR2300074273).

Peng W ，Chu R ，Cui W ，Zhuang Y ，Chen W ，Han X ，Sun Z ，Zhang S ... -  《BMC MUSCULOSKELETAL DISORDERS》

Short-term efficacy of unilateral biportal endoscopy technology in the treatment of cervical spondylotic radiculopathy.

Wen M ，Li X ，Lu X ，Chen T ，Qin R ... -  《-》

Correlation analysis between preoperative odontoid incidence and clinical outcomes 2 years after anterior cervical discectomy and fusion.

This study presents a novel odontoid parameter, the odontoid incidence (OI), to examine the correlation between OI on preoperative cervical sagittal radiographs and 2-year clinical outcomes following short-segment anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM). A retrospective analysis of the clinical data of 87 patients with CSM who underwent ACDF surgery from January 2018 to December 2023 was conducted. The patients were categorized into a larger OI group (44 patients, OI > 12.62°) and a smaller OI group (43 patients, OI ≤ 12.62°) on the basis of the median cervical sagittal OI prior to surgery. The postoperative follow-up duration was 2 years. Cervical sagittal parameters were assessed on lateral cervical spine radiographs both preoperatively and postoperatively. Additionally, the Japanese Orthopedic Association (JOA), neck disability index (NDI), and visual analog scale (VAS) scores were documented for each patient before surgery and at the final 2-year postoperative follow-up. Compared with those in the preoperative period, the T1 slope, C2‒C7 Cobb angle, sagittal segmental angle (SSA), and C0‒C2 Cobb angle significantly improved in 87 patients with cervical spondylosis (P < 0.05). At the 2-year postoperative follow-up, all patients exhibited significant improvements in JOA, NDI, and VAS scores compared with the preoperative values (P < 0.05). No statistically significant difference was observed in the preoperative or baseline data between the larger OI group and the smaller OI group (P > 0.05); however, a statistically significant difference was noted in the postoperative SSA between the two groups (P < 0.05). A statistically significant difference was observed in the VAS score and NDI score at the final follow-up between the two groups (P < 0.05), as well as in the improvement in the JOA score and VAS score (preoperative score minus the final follow-up score), between the two groups (P < 0.05). The results of the Pearson correlation analysis indicated a negative correlation between the preoperative OI score and the VAS and NDI scores at the final postoperative follow-up (P = 0.012, r = - 0.268) (P = 0.028, r = - 0.236). In ACDF, the preoperative OI of patients with CSM was negatively correlated with the VAS and NDI scores at the final postoperative follow-up; Larger preoperative OI corresponded to lower VAS and NDI scores at the final follow-up, leading to comparatively improved 2-year clinical outcomes.

Gong Y ，Liu H ，Gan Y ，He J ，Zhou Z ，Zhuo H ，Liu Y ，Liang D ，Ren H ，Jiang X ，Cheng Z ... -  《-》

[Zero-profile intervertebral fusion with cage-titanium plate for the treatment of multilevel cervical spondylotic myelopathy].

Zhong JB ，Hu Y ，Chu ZT ，Dong WX ，Yuan ZS ，Sun XY ，Zhu BK ，Lai OJ ... -  《-》