Clinical study on the efficacy and safety of percutaneous endoscopic anterior cervical discectomy in the treatment of cervical disc herniation

Purpose To compare the clinical efficacy of anterior percutaneous endoscopic cervical discectomy (APECD) and anterior cervical decompression and fusion (ACDF) in the treatment of cervical disc herniation. Methods A total of 115 cases of cervical disc herniation treated in our hospital from May 2016 to August 2018 were selected. The subjects were divided into APECD and ACDF groups. The operation time, intra-operative blood loss, and hospital stay of the two groups were recorded and compared, and the clinical symptoms were recorded at one week, one year, and two years after the operation. The neck and upper limb visual analog scale (VAS) score, Japanese Orthopedic Association (JOA) score, cervical range of motion (ROM), post-operative cervical lordosis angle and adjacent vertebral body height were compared between the two groups. Results All 115 patients underwent successful operations. The intra-operative blood loss and operation time in the APECD group were significantly less than those in the ACDF group ( P < 0.05). There were no oesophago-tracheal sheaths, carotid artery sheaths, cervical sympathetic trunks, vertebral artery injuries, or dural tears in the two groups. The JOA and VAS scores of the two groups significantly improved from pre- to post-operatively, but there were no significant differences between the two groups at the last follow-up ( P > 0.05). The post-operative radiological results showed that the herniated cervical intervertebral disc was removed completely. One year after the operation, the cervical lordosis angle increased significantly in both groups ( P < 0.05). However, ROM decreased significantly in the ACDF group ( P < 0.05), and there was no significant change in ROM in the APECD group ( P > 0.05). The cervical lordosis angle did not significantly differ between the two groups at the last follow-up ( P > 0.05), but there was a significant difference in ROM between the two groups at the last follow-up ( P < 0.05). In the ACDF group, the height of the adjacent vertebral body increased 1 year after the operation ( P < 0.05). In the APECD group, the height of the adjacent vertebral body decreased one year after the operation, but the value was not significantly different from the pre-operative value ( P > 0.05). There was a significant difference in the height of the adjacent vertebral body between the two groups at the last follow-up ( P < 0.05). The incidence of post-operative complications did not significantly differ between the two groups ( P > 0.05). Conclusion APECD is a minimally invasive treatment that is safe and effective. The medium- and short-term effects of APECD and ACDF in the treatment of cervical disc herniation are similar. In addition, APECD is superior to ACDF in the operation time, intra-operative blood loss, and ROM. However, prospective, multicenter studies with longer follow-up periods need to be conducted, and the recurrence rate and intervertebral height loss need to be studied.