Early efficacy of percutaneous endoscopic cervical discectomy with multimodal neurophysiological monitoring

Abstract

Objective: To explore the clinical efficacy of percutaneous endoscopic cervical discectomy (PECD) assisted by neurophysiology monitoring (NM) in the treatment of cervical spondylotic radiculopathy (CSR). Methods: The clinical data of 55 patients with CSR treated in the Department of Spinal Surgery of Henan Provincial People's Hospital from April 2015 to May 2018 were analyzed retrospectively. Among them, 29 patients were treated with multi-mode NM-assisted PECD (NM group) and 26 patients with PECD alone (PECD group). The gender, age, operation time, bleeding volume, average hospital stay and complications between the two groups were recorded and compared. In addition, the visual analogue score (VAS) of neck and upper limb pain and the score of Japanese Orthopedic Association (JOA) were compared between the two groups before operation, 1 month after the operation and at the last follow-up. These data between groups were compared by independent sample t test. Results: All patients in both groups were followed-up for at least 18 months. Neck VAS and upper limb VAS scores of two groups at 1 month post operation (neck: 2.1±1.2, 2.0±1.1; upper lamb: 2.4±1.2, 2.2±0.8) and the last follow-up (neck:0.8±0.5, 0.7±0.5; upper lamb: 0.8±0.7, 0.8±0.5) decreased significantly when compared with those before the operation (neck: 6.0±1.0, 5.9±1.0; upper lamb: 7.1±0.9, 7.4±0.9) (t=12.670-27.305, all P<0.05). However, there was no significant difference between the two groups (t=-1.107-0.917, all P>0.05). JOA scores of two groups at 1 month after the operation (12.7±0.8, 12.6±0.8), and at the last follow-up (14.6±0.7, 14.4±0.8) were all improved significantly from those before the operation (11.1±1.0, 10.9±0.8) (t=-11.074, -14.829, -9.603, -13.086, all P<0.05); however, there was no significant difference between the two groups (t=0.842, 0.003, both P>0.05). There was also no significant difference in bleeding volume, and operation time between the two groups, (t=-0.615, -0.922, P>0.05) but the average hospital stay and incidence of complications in the NM group were significantly lower than those in the PECD group (t=-2.815, χ(2)=4.755, both P<0.05). Conclusion: Multimode NM-assisted PECD in the treatment of CSR achieves satisfactory results, reducing the average hospital stay, reducing complications and improving surgical safety.