ObjectiveTo investigate the clinical feasibility, safety, and effectiveness of posterior percutaneous endoscopy via vertical anchor technique combined with trench technique for single-segmental central cervical disc herniation.MethodsBetween July 2017 and August 2019, 13 patients with the single-segmental central cervical disc herniation suffering from various neurologic deficits were treated with posterior percutaneous endoscopy via vertical anchor technique combined with trench technique. There were 6 males and 7 females with an average age of 50.5 years (range, 43-64 years). Disease duration ranged from 3 to 17 months (mean, 9.2 months). The clinical symptoms of 5 cases were mainly neck pain, radiculopathy, and numbness in upper limbs, and the visual analogue scale (VAS) score was 6.60±0.55. The clinical symptoms of 8 cases were myelopathy including upper extremities numbness, weakness, and trouble walking, and the modified Japanese Orthopedic Association (mJOA) score was 12.75±0.71. The surgery-related complications, operation time, and intraoperative blood loss were recorded, and the results of clinical symptoms were measured by VAS scores and mJOA scores.ResultsAll procedures were completed successfully, no severe complications such as dural tears or cerebrospinal fluid leakage occurred. The operation time ranged from 83 to 164 minutes (mean, 101.2 minutes). The intraoperative blood loss was 25-50 mL (mean, 33.1 mL). After operation, 12 of 13 cases were followed up 10-24 months (mean, 17.6 months). The VAS scores of patients with preoperative pain symptoms were 2.40±0.55 on the first day after operation and 1.80±0.45 at last follow-up, which were significantly lower than those before operation (P<0.05). The mJOA scores of patients with the symptoms of spinal cord injury were 12.63±0.52 on the first day after operation and 14.29±0.95 at last follow-up, and the score at last follow-up was significantly higher than that before operation (P<0.05). Acute extremities weakness occurred for the postoperative hematoma formation in 1 case (disc herniation at C4, 5) presented with myelopathy preoperatively, and muscle strength was recovered after the clearance of hematoma and spinal cord decompression under percutaneous endoscopy.ConclusionPosterior percutaneous endoscopy via vertical anchor technique and trench technique for single-segmental central cervical disc herniation was clinical feasible, safe, and effective, and could be an alternative approach to the treatment of central cervical disc herniation.
Objective To observe the early effectiveness of cervical disc replacement with Pretic-I, a new type artificial disc. Methods A retrospective analysis was made on the clinical data of 10 patients who underwent single segmental cervical disc replacement with Pretic-I from June to December 2014. Among 10 patients, 4 were male and 6 were female, with an average age of 40 years (range, 27-51 years). The mean disease duration was 15.4 months (range, 4-36 months). Affected segments located at C4, 5 level in 1 case, at C5, 6 level in 8 cases, and at C6, 7 level in 1 case. The visual analogue scale (VAS), Japanese Orthopaedic Association (JOA) score, and neck disability index (NDI) were used to evaluate the clinical outcomes. Besides, the disc height and the range of motion (ROM) at operated level, and ROM of upper and lower adjacent level were measured to assess the function. Results The operation was successfully completed in all patients who were followed up for 12 months. No complications of aggravated nerve symptoms, vertebral artery injury, esophagotracheal fistula, cerebrospinal fluid leakage, incision infection, hematoma and prosthetic loosening were observed during follow-up. The VAS score, JOA score, and NDI significantly improved at each time point after operation when compared with preoperative scores (P<0.05). The height of intervertebral disc at operated level was significantly increased at immediate and 3 months after operation when compared with preoperative one (P<0.05), but no significant difference was found between at 6 months or 12 months after operation and at pre-operation (P>0.05). No significant difference was shown in the ROM at operated level, and ROM of upper and lower adjacent level between at pre-operation and at each time point after operation (P>0.05). Conclusion The early effctiveness of cervical disc replacement using Pretic-I is satisfactory. The symptoms can be relieved significantly and the dynamic features of the operated level, as well as the upper and lower adjacent levels, are well preserved.
Objective To investigate the correlation between cervical sagittal imbalance, disc morphology, and localized ossification of the posterior longitudinal ligament (LOP) in patients with single-level cervical disc herniation. Methods A cross-sectional study was conducted on 150 patients with single-level cervical disc herniation and complete imaging data (including standard X-ray film, CT, and MRI). Patients were divided into the LOP(+) group (n=76, with LOP at the herniated segment) and the LOP (?) group (n=74, without LOP) based on the presence of LOP. Univariate and logistic regression analyses were performed to identify factors associated with LOP, including gender, age, body mass index, C-reactive protein, fasting blood glucose, serum uric acid, maximum diameter of herniated disc, the maximum base width of herniated disc, spinal canal occupancy rate, height of intervertebral space, Pfirrmann grade of disc degeneration, C2-7 Cobb angle, T1 slope, cervical sagittal vertical axis (cSVA), C2-7 Cobb angle in extension/flexion, global cervical range of motion (ROM), and extension/flexion angle and ROM at the index level. Pearson or Spearman correlation was used to analyze the correlation of the main imaging parameters between the two groups. Results Univariate analysis showed that Pfirrmann grade, maximum base width of herniated disc, spinal canal occupancy rate, height of intervertebral space, C2-7 Cobb angle, extension angle and ROM at the index level were the influencing factors of LOP (P<0.05). Further logistic regression analysis revealed that the increase of the maximum base width of the herniated disc and the decrease of the spinal canal occupancy rate were the independent influencing factors of LOP (P<0.05). Correlation analysis showed that the correlation patterns among the main radiological parameters were not identical between the LOP (?) and LOP (+) groups. In both groups, the C2-7 Cobb angle was positively correlated with T1 slope (P<0.05), and some segmental motion parameters were correlated with global cervical ROM and dynamic C2-7 Cobb parameters (P<0.05). In the LOP (+) group, spinal canal occupancy rate, cSVA, OPLL thickness, and disc morphological parameters also showed certain correlations (P<0.05). Conclusion Cervical sagittal imbalance (characterized by reduced lordosis and segmental mobility) and disc base expansion are significantly associated with LOP coexistence in single-level cervical disc herniation patients. These imaging markers may aid early identification of high-risk populations in clinical settings.