Treatment Of Cervical Disc Herniation Research Articles

Influence of Preoperative Disability on Outcomes Following Primary Surgical Treatment of Cervical Disc Herniation.

Retrospective review. To evaluate how preoperative disability influences patient-reported outcomes (PROs) following primary surgical intervention for cervical herniated disc. The effect of baseline disability has been evaluated for various spinal surgeries, but not specifically for primary cervical herniated disc. A prospectively maintained single surgeon database was retrospectively reviewed to identify patients who underwent primary cervical spine surgery for herniated nucleus pulposus. Demographics, perioperative data, and baseline/postoperative PROs were collected including Neck Disability Index (NDI), Visual Analog Scale-Arm/Neck (VAS-A/N), 12-Item Short Form Mental/Physical Component Scores (SF-12 MCS/PCS), Patient-Reported Outcome Measure Information System-Physical Function (PROMIS-PF), and 9-Item Patient-Health Questionnaire (PHQ-9). Baseline NDI <50/≥50 defined 2 cohorts. ΔPROs were determined at 6-week postoperatively/final follow-up (average 11.8±7.7 postoperative months). Overall rates of minimal clinically important difference (MCID) achievement were determined for each PRO. Perioperative characteristics/demographics/baseline PROs were compared with χ2 tests (categorical variables)/the Student t test (continuous variables). Intercohort postoperative PROs/ΔPROs/MCID attainment rates were compared with multivariate linear regression (continuous variables)/multivariate logistic regression (categorical variables) accounting for differences in insurance type. Of 190 patients, there were 69 in the NDI ≥50 group. Patients with NDI ≥50 were more likely to have workers' compensation, or Medicare/Medicaid insurance (P<0.001) and report worse baseline PROs (P≤0.001, all). After controlling for insurance type, NDI ≥50 patients continued to report worse PROs at 6 weeks/final follow-up (P≤0.037, all), except PROMIS-PF at 6 weeks postoperatively. NDI ≥50 patients reported greater NDI improvements at 6 weeks (P=0.007) and final follow-up (P<0.001). NDI ≥50 patients experienced higher overall MCID achievement rates for PHQ-9/NDI (P≤0.015, both). NDI ≥50 patients reported worse baseline mental/physical health and neck/arm pain and continued to report inferior postoperative outcomes including disability. Despite inferior absolute outcomes, NDI ≥50 patients reported greater improvements/achievement of clinically significant differences in disability through final follow-up. Further, these patients were more likely to experience clinically significant improvements in depressive burden.

Collagenase Chemonucleolysis for Treating Cervical Disc Herniation: An Exploratory, Single-Arm, Open-Label, Multicenter Clinical Trial.

Cervical disc herniation (CDH) is the most common cause of cervical radiculopathy and causes persistent neck pain and neurological deficits. Collagenase chemonucleolysis has been successfully applied to treat lumbar disc herniation, which has a similar pathological mechanism to CDH. However, its application for CDH remains under-researched, and there is an even greater lack of high-quality clinical evidence. This study aims to evaluate the efficacy and safety of collagenase chemonucleolysis for treating CDH. Eligible patients with CDH underwent collagenase chemonucleolysis via anterior cervical intradiscal injection or epidural injection. The primary efficacy endpoint showed an excellent and good rate regarding the Odom criteria, which was not lower than the reference value (≥ 78%) at 6 months postoperatively. The secondary efficacy endpoints were the percentage reduction in Numeric Rating Scale (NRS) and Neck Disability Index (NDI) scores from baseline, which were not lower than the reference values (≥ 40%, ≥ 30%), and improvement in the 36-Item Short Form Health Survey (SF-36) score compared to the preoperative value. The pre- and postoperative CDH index of patients were also compared. Safety endpoints included the incidence of adverse events (AEs) and serious adverse events (SAEs). An excellent and good rate regarding the Odom criteria 6 months postoperatively was 90.5% (133/147), which was significantly higher than 78% (P < 0.004, 95% confidence interval 85.7-95.2%). The reduction in NRS and NDI scores exceeded 40% (P < 0.001) and 30% (P < 0.001), respectively. The SF-36 scores at 3 months and 6 months postoperatively were significantly higher than those preoperatively (P < 0.001). A significant difference was observed in the pre- and postoperative CDH index (109.6 ± 119.1 vs. 70.8 ± 74.8, P < 0.001). The incidence of AEs was 22.5% (33/147), of which 97.8% were grade 1-2. No collagenase-related AEs and SAEs occurred. Collagenase chemonucleolysis treatment for CDH exhibited favorable efficacy and safety and may be a better choice for patients in whom conservative treatment is ineffective. The trial was registered on www.Chictr.org.cn (ChiCTR2200063043).

P203. Influence of preoperative disability on outcomes following primary surgical treatment of cervical disc herniation

P203. Influence of preoperative disability on outcomes following primary surgical treatment of cervical disc herniation

Clinical effects of endoscope-assisted anterior cervical discectomy, fusion, internal fixation, and conventional surgery on treatment of cervical disc herniation

Clinical effects of endoscope-assisted anterior cervical discectomy, fusion, internal fixation, and conventional surgery on treatment of cervical disc herniation

Evaluation of the effectiveness of complex physical therapy and SIS-therapy in the treatment of cervical disc herniation in the cervical spine

This article provides a review of the literature evaluating treatments for cervical disc herniation.&#x0D; As the most common cause of neck pain and even disability, cervical disc herniation often requires a multifaceted approach to treatment. The author examines the effectiveness of complex exercise therapy, including a number of therapeutic exercises and methods of manual therapy and SIS-therapy, using a high-intensity magnetic field. The review contains a description of various clinical trials, and also presents comparative functional characteristics of these methods to assess the effectiveness, safety and effectiveness of treatment. The author conducted a comparative analysis of the SIS-therapy method with the exercise therapy method in the treatment of herniated discs of the cervical spine based on consideration of such aspects of their impact as the mechanism of action, effectiveness, safety, accessibility and convenience, time and cost, and overall impact on health. The results show that complex exercise therapy and SIS-therapy are the most promising non-invasive treatment methods that can significantly improve the degree of pain relief, mobility and overall quality of life of patients with cervical disc herniation. The article provides recommendations for the implementation of these treatment methods in clinical practice and suggestions for further directions of research.

The Role of Cervical Disc Arthroplasty in Elite Athletes.

Cervical disc arthroplasty (CDA) for the treatment of symptomatic cervical disc herniations (CDH) is a promising treatment for professional athletes. In recent years, a number of high-profile athletes have returned to professional play within three months after CDA, raising important questions about the potential of this procedure within this patient group. We provide the first comprehensive review of available literature for the safety and efficacy of CDA in professional contact sport athletes. CDA provides theoretical biomechanical advantages over anterior cervical discectomy and fusion (ACDF) and posterior foraminotomy (PF), as CDA is the only operation for treatment of CDH that provides neural decompression, stability and height restoration, with preserved range of motion. While the comparative long-term results from each procedure are unknown, CDA has provided encouraging promise in its use in professional contact athletes. We aim to aid ongoing discussions regarding the controversies in spine surgery for professional athletes by providing a scientific review of the available evidence-based literature involving cervical disc arthroplasty in this population. In general, we believe that CDA is a viable alternative to ACDF and PF for the contact professional athlete who requires full neck range of motion and desires an expedited return to play. For collision athletes, the short- and long-term safety and efficacy profile of this procedure is promising but still unclear.

Ultrasound-guided Percutaneous Laser Disc Decompression (PLDD) with Fluoroscopic Validation for the Treatment of Cervical Disc Herniation: Technical Note.

Percutaneous laser disc decompression (PLDD) has been regarded as an effective alternative for the treatment of cervical soft disc herniations. Repeated X-Ray scanning is essential when performing this technique. Technical note. We present a new method for the treatment of cervical disc herniation using ultrasound to guide the needle entry to the cervical disc, to avoid excess of radiation exposure during the surgical procedure. We evaluated the efficacy of this cervical approach. We retrospectively reviewed the clinical data of 14 cases who underwent a PLDD under ultrasound guidance for the treatment of contained cervical disc herniation using a 1,470 Nm diode laser. The lower cervical discs (C5-C6 and C6-C7) were the most affected sites, accounting for 78.6% of surgical discs. A significant NRS reduction between baseline and 1 month (P = .0002) and between baseline and 12 months (P = .0007) was observed. Our results support the conclusion that ultrasound guided PLDD with fluoroscopic validation is a minimally invasive technique for patients affected by herniated cervical discs, but proper choice of patients is critical. This approach should not be performed except after adequate training under close supervision of surgeons experienced in this procedure and in interventional US.

Biportal endoscopic spine surgery for cervical disk herniation: A technical notes and preliminary report.

Biportal endoscopic spine surgery (BESS) for cervical disk herniation (CDH) has been rarely reported. The aim of the article is to describe a novel BESS as a posterior approach for CDH and report the preliminary outcomes and complications. This single-centered retrospective chart review included 109 consecutive patients who underwent BESS for symptomatic single-level CDH. Working and viewing portals were created in each unilateral paravertebral area at the target disk level. Endoscopic exploration allowed for effective and minimally invasive decompression via safe access to the medial foramen with minimal laminectomy and facetectomy. Clinical outcomes, including the visual analog scale, neck disability index, Macnab criteria, and the motor function of the involved arm, were evaluated at 4, 8, 12, and 24 postoperative weeks. Visual analog scale and neck disability index improved significantly at 24 weeks postoperatively (P < .01). According to the Macnab criteria, “excellent,” “good,” and “fair” results were obtained for 55.9%, 30.3%, and 13.8% of patients, respectively. The post 24-week distribution of the involved upper extremity strength grade was significantly improved compared to the initial value (P = .02). One patient had a motor weakness with a decreased grade over 4 weeks from excessive irrigation. The posterior approach of BESS was efficient and feasible for the treatment of CDH.

Initial evaluation of pain relief efficacy of ultrasound-guided selective nerve root injection with corticosteroid in the treatment of cervical disc herniation

Objective: To evaluate the pain relief efficacy of selective nerve root injection with corticosteroid under ultrasound’s guidance in the treatment of the cervical disc herniation and its complications. Subject and method: The study was conducted with 20 cervical disc herniation patients in the Center of Multidisciplinary Consultation and Treatment, 108 Military Central Hospital from February 2021 to May 2021. All included patients were examined and performed the first injection, then observed for 2 hours after the procedure. The second injection would be indicated if the first one was not able to relieve 50% of pain at each time points of study. The time points of study were T0, T1, T2, T3 according to before, at a time, and after intervention 2 weeks and 4 weeks. The researched outcomes were vital signs, general status, Numeric Rating Scale (NRS, for pain assessment), and complications. Result: The average age of subjects was 54.75 ± 12.07 years old. Gender ratio (male/female) was 1.22. The most common herniated level was C5-C6 (90%), mainly right orientation (67%). The most frequent compressed nerve root was C6 right (67%). The NRS score at the time points after intervention significantly reduced, and this favorable outcome steadily maintained (p&lt;0.05). The most popular complication was the parasympathetic reflex (10%), it gradually disappeared with conservative care. There was no severe complication. Conclusion: The selective nerve root injection with corticosteroid under ultrasound’s guidance in the treatment of cervical disc herniation is the acceptably safe and effective management.

Percutaneous Full-Endoscopic Anterior Transcorporeal Cervical Discectomy for the Treatment of Cervical Disc Herniation: Surgical Design and Results

Studies that focus on percutaneous full-endoscopic anterior transcorporeal cervical discectomy (PEATCD) have rarely been reported. Therefore, the available data on the surgical design of PEATCD and related clinical outcomes are very limited. To design a surgical plan for PEATCD and to evaluate its clinical efficacy in clinical application. A retrospective cohort study. A center for spine surgery, rehabilitation department and pain medicine. Based on the size and precise location of the disc protrusions on magnetic resonance imaging (MRI), the diameter and direction of the bone channel were designed to make a surgical plan for PEATCD. A total of 26 patients with central/paracentral cervical disc herniation (CDH) who underwent PEATCD through the designed surgical plan from October 2015 to September 2016 were enrolled in the retrospective study. Clinical outcome evaluations included Visual Analog Scale (VAS) scores, Japanese Orthopedic Association (JOA) scores, and the modified Macnab criteria. Radiologic follow-up included cervical computerized tomography (CT) and MRI evaluations. The diameter of the designed bone channel was about 7.5 mm, and the direction was from the upper edge of the lower endplate obliquely toward the disc protrusion. Through the designed surgical plan, 26 cases of discectomy were successfully completed. The average operation time was 91.50 ± 16.80 min, and the average hospital stay was 4.07 ± 0.84 days. All patients were followed for an average of 19.61 ± 4.04 months. The postoperative VAS and JOA scores were significantly improved compared with the preoperative scores (P < 0.0001). Clinical efficacy at the final follow-up was evaluated by the modified Macnab criteria, and the excellent and good rate was 92.31%. Postoperative MRI showed that the disc protrusion was completely removed, and CT showed no collapse of the vertebral body. This study has several limitations, including the lack of a control group, the small sample size, and the unavoidable nature of the single-center study design. Based on the size and location of the disc protrusion on MRI, the diameter and direction of the bone channel are designed, which is conducive to have enough space under the full-endoscopic field of view to completely expose and remove the disc protrusion, to avoid residuals, and to ensure that PEATCD achieves good therapeutic results. The study was registered at Chinese Clinical Trial Registry (ChiCTR1900027820).

Effects on pain of percutaneous treatment of cervical disc herniations using DiscoGel: A retrospective analysis.

Cervical discogenic pain originates from degenerated intervertebral discs and is a common condition in the middle-aged population. Cervical discs may herniate and give compressions to cervical nerves, with pain and functional limitation of the arms. DiscoGel is a device that can be useful in the treatment of cervical disc herniation, with very short operating time and low radiation dose. Between March 2018 and April 2019 we performed this procedure on 38 patients with non-fissurated cervical herniation using 0.3-0.4 mL of DiscoGel injected under fluoroscopic guidance. The most common discs affected were C5-C6, C6-C7 and C4-C5. Outcomes were evaluated with Visual Analogue Scale (VAS) and Neuropathic Pain Symptom Inventory (NPSI) scores at 3, 6 and 12 months follow-up. A magnetic resonance imaging (MRI) scan of the cervical spine was performed 3 months after the procedure. Postoperative examinations showed: VAS 2.15 ± 1.34 and NPSI 2.29 ± 0.71.Postoperative MRI performed 3 months after the procedure showed a good improvement of cervical disc herniation or bulging or protrusion. The mean dose area product (DAP) was 2803 mGy/cm2 with a mean fluoroscopy time of 4 minutes 22 seconds.Conclusion DiscoGel is a suitable approach for non-fissurated cervical disc herniations, especially in patients that are not suitable for open surgery, with excellent postoperative results, fast recovery and a low radiation dose.

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

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. 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. 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). 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.

Comparative evaluation of posterior percutaneous endoscopy cervical discectomy using a 3.7\u2009mm endoscope and a 6.9\u2009mm endoscope for cervical disc herniation: a retrospective comparative cohort study

BackgroundPosterior percutaneous endoscopy cervical discectomy (p-PECD) is an effective strategy for the treatment of cervical diseases, with a working cannula ranging from 3.7 mm to 6.9 mm in diameter. However, to date, no studies have been performed to compare the clinical outcomes of the use of endoscopes with different diameters in cervical disc herniation (CDH) patients. The purpose of this study was to compare the clinical outcomes of patients with unilateral CDH treated with p-PECD using a 3.7 mm endoscope and a 6.9 mm endoscope.MethodsFrom January 2016 to June 2018, a total of 28 consecutive patients with single-level CDH who received p-PECD using either the 3.7 mm or the 6.9 mm endoscope were enrolled. The clinical results, including the surgical duration, hospitalization, visual analog scale (VAS) score and modified MacNab criteria, were evaluated. Cervical fluoroscopy, CT, and MRI were also performed during follow-up.ResultsTthere was a significant difference in regard to the average identification time of the “V” point (18.608 ± 3.7607 min vs. 11.256 ± 2.7161 min, p < 0.001) and the mean removal time of the overlying tissue (16.650 ± 4.1730 min vs. 12.712 ± 3.3079 min, p < 0.05) for the use of the 3.7 mm endoscope and the 6.9 mm endoscope, respectively. The postoperative VAS and MacNab scores of the two endoscopes were significantly improved compared with those the preoperative scores (p < 0.05).ConclusionThe application of both the 3.7 mm endoscope and 6.9 mm endoscope represent an effective method for the treatment of CDH in selected patients, and no significant difference can be observed in the clinical outcomes of the endoscopes. The 6.9 mm endoscope shows superiority to the 3.7 mm endoscope in terms of the efficiency of “V” point identification, the removal of overlying soft tissue and the prevention of spinal cord injury. However, the 6.9 mm endoscope may be inferior to the 3.7 mm endoscope in regards to anterior foraminal decompression due to its large diameter; this result needs to be further evaluated with the support of a large number of randomized controlled trials.

Atualização no tratamento da hérnia discal cervical: Manejo conservador e indicações de diferentes técnicas cirúrgicas

SummaryCervical and root pain due to herniated disc is one a common cause of a visit to an orthopedic surgeon. It is important to know how to diagnose, treat and initially.What are the best options to treat a herniated disc nowadays? The present article reviews the literature and updates on the clinical and surgical treatment of cervical disc herniation.

Treatment of cervical spondylotic radiculopathy by posterior foraminal resection of nucleus pulposus

To introduce the surgical technique of percutaneous posterior foraminal resection of cervical disc herniation in our hospital and the clinical results of 1 case.[Methods] Imaging diagnosis was C6-7 disc herniation and compression of left nerve root and dural sac. After adequate preoperative preparation, posterior foraminal resection of cervical disc herniation was performed.[Results] The prolapsed nucleus pulposus tissue was removed successfully, and the pain and numbness symptoms of the patient's neck and shoulder were improved on the first day after surgery, and the surgical incision healed well. One week later, the range of motion of the cervical spine and the function of the vertebral body were restored, and the pain and numbness symptoms completely disappeared.[Conclusion] Nucleus pulposus excision by posterior percutaneous foraminal approach in the treatment of cervical disc herniation has good clinical effect and prognosis.

Surgical Treatment of the Patients with Cervical Disc Herniation at Clinical Center of University of Sarajevo, Bosnia and Herzegovina.

Backgroud:Intervertebral disc herniations are caused by rupture of the fibrous ring and migration of one part of the nucleus pulposus towards the spinal canal. The most commonly affected levels are C5-C6 and C6-C7. Surgical treatment of cervicobrachialgia is indicated in the presence of long-term intense pain syndrome with or without radicular sensory-motor deficit and magnetic resonance (MRI) verified disc herniation with a compressive effect.Objective:The most common surgical treatment is anterior lateral microdiscectomy with or without the use of implants. In addition to this method, dorsolateral microsurgical treatment can be used for foraminal hernias.Methods:This retrospective study included 110 (58 / 52.7% male and 52 / 47.3% female) patients with cervical disc herniations who were surgically treated at the Neurosurgery clinic of Clinical Center of Sarajevo University (CCUS) in a five-year period. Stability, postoperative curvature, arthrodesis, implants, and changes in adjacent segments were radiographically analyzed. In the outcome assessment, functional outcome and patient satisfaction were analyzed using the Pain Self-Evaluation Scale (VAS), Prolo functional and economic score, and White’s classification of treatment outcomes.Results:The dominant prevalence of changes was recorded at the levels of C5-C6 (58%) and C4-C5 (28%) with a ventrolateral approach performed in 90% of patients. The largest representation is hard dorsolateral discs (n = 77). In the group of patients with placed implant, hard discs were present in 96 (90%) cases (p <0.001), while soft discs were dominant in patients without implant placement (p <0.001). In the group of subjects with implant, the most common are hard dorsolateral discs and those of mixed localization in 41 of 55 patients (65.5%; p = 0.001). The most common implant is PEEK cage (74.5%). From complications, we had partial vertebral body fractures in 4.5% of patients. Furtehr, the most common are sensory disturbances in 2.73% of respondents. Reduction of symptoms and improvement of preoperative neurological status were observed in over 95% of patients.Conclusion:Surgical treatment of cervical disc herniation is a safe method with a minimal percentage of complications. Microsurgical discectomy significantly contributes to the improvement of the functional status of patients, the reduction of pain, and the improvement of neurological deficit and overall mobility.

Anterior Cervical Microdiscectomy and Fusion using Stand-Alone Polyetheretherketone Cage: A Retrospective Study

Introduction: Anterior Cervical Discectomy and Fusion (ACDF) constitutes the standard mode of treatment for cervical disc herniation due to degeneration. Stand-alone cage can be considered as effective treatment for single and two level disc prolapse. Aim: To examine the clinical outcomes of ACDF using stand- alone Polyetheretherketone (PEEK) cage in a single centre. Materials and Methods: This retrospective study was conducted from July 2015 to Dec 2020 in 224 consecutive patients who underwent successful ACDF using self-locking stand-alone PEEK cage, study was done at Shri Dharmasthala Manjunatheshwara tertiary care hospital, Dharwad, Karnataka, India for radiculopathy or myelopathy due to cervical degenerative disc disease. Data analysis was done upto March 2021. The patients were analysed with Visual Analogue Scale (VAS) pain score for neck and arm pain and Nurick grade preoperatively and at 3 months postoperatively. Patients underwent preoperative and postoperative clinical, neurological evaluation. This study was statistically analysed using the Statistical Package for the Social Sciences (SPSS version 13.0) (IBM, Chicago, IL). Results: Out of 244, (73%)164 patients underwent single level ACDF and sixty (27%) two-level ACDF. The mean age of patients was 45.86±12.07. It included 146 (65.2%) males and 78 (34.8%) female patients. In this study, the mean VAS neck score preoperatively was 4.04 and at 3 months postoperatively was 1.66 which was statistically significant (p&lt;0.001). Even in VAS arm scores, there was a statistical significant difference (p&lt;0.001) between preoperative (7.25) and 3 months postoperative (1.63) scores. The mean Nurick grade preoperatively was 1.46 vs 0.40 postoperatively which was statistically significant (p&lt;0.001). No implant related complications or adjacent level disease was noted. Conclusion: This study demonstrated that treatment of cervical degenerative disc disease by ACDF withstand alone PEEK cage is an effective and safe method.

Analysis of compliance and efficacy of integrated management of whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation

BackgroundPercutaneous spinal endoscopy is a new type of surgery for the treatment of cervical disc herniation. It can avoid the complications of the classic anterior cervical discectomy and fusion (ACDF) approach and the risk of adjacent spondylosis. How can we effectively improve patients’ awareness of spinal endoscopy and their election of endoscopic techniques?ObjectiveTo analyze the compliance and clinical effect of the integrated management of the whole process in the choice of percutaneous full-endoscopic surgery for patients with cervical disc herniation.MethodsRetrospective analysis of 72 patients with cervical disc herniation undergoing surgery in our hospital from August 2015–August 2017 was performed. The whole-process integrated management model was used for all the patients. The 36 patients in the experimental group were treated by percutaneous full-endoscopic cervical discectomy, and the 36 patients in the control group were treated by ACDF. The postoperative feeding time, time to get out of bed, length of hospital stay, compliance, clinical efficacy, and recurrence rate of neck pain were observed. Changes between the preoperative and postoperative pain visual analog scale (VAS) scores and neurological function Japan Orthopaedic Association (JOA) scores were assessed.ResultsThe postoperative feeding time in the experimental group was 8.319 ± 1.374 h, the postoperative time to get out of bed was 16.64 ± 3.728 h, and the hospitalization time was 6.403 ± 0.735 days. The excellent and good clinical efficacy rate was 91.67%, the compliance rate was 88.89%, and the neck pain recurrence rate was 5.56%. The postoperative feeding time in the control group was 26.56 ± 9.512 h, the postoperative time to get out of bed was 45.06 ± 9.027 h, and the length of hospital stay was 8.208 ± 0.865 days. The excellent and good clinical efficacy rate was 88.89%, the compliance rate was 69.4%, and the neck pain recurrence rate was 8.33%. There was no significant difference between the two groups in the excellent efficacy rate and the neck pain recurrence rate, p > 0.05. The compliance rate in the experimental group was better than that in the control group, and the difference was statistically significant, p < 0.05. The hospitalization time of the experimental group was significantly lower than that of the control group, and the difference was statistically significant, p < 0.05. The postoperative VAS scores and JOA scores of the two groups were significantly better than the preoperative scores, and the difference was statistically significant, p < 0.05; there was no significant difference between the two groups, p > 0.05.ConclusionThe integrated management of the whole course can effectively improve the compliance of patients with cervical disc herniation receiving endoscopic treatment, yield the same treatment effect as the classic operation, shorten the hospitalization time, speed up the turnover of hospital beds, and improve satisfaction with medical quality and is worthy of clinical application.

Posterior percutaneous endoscopic versus traditional surgery for cervical disc herniation: A protocol for systematic review and meta analysis.

Background:Posterior percutaneous endoscopic cervical diskectomy (P-PECD) can be used posterior microdiscectomy for cervical disc herniation. But only some small sample sizes of clinical studies have evaluated the efficacy and safety of P-PECD. This study aim to evaluated the efficacy and safety of P-PECD compared with traditional open surgery.Methods:We will search the following seven electronic databases from their initiation to the May 1, 2020: PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), Chinese Biomedical Literature Database (CBM) and Wanfang database. All randomized controlled trials, non-randomized controlled trials and retrospective case controls that compared the efficacy and safety of P-PECD and traditional open surgery in the treatment of cervical disc herniation will be included. The pooled odds ratio with 95% credible intervals (CIs) was used for the dichotomous variables. The mean difference with 95% CIs was used for the continuous variables. All analyses were conducted by Comprehensive Meta Analysis 2.0. A 2-tailed P value < 0.05 is considered statistically significant.Results:The results of systematic review and meta-analysis will be submitted to a peer-reviewed journal.Conclusion:Our study will provide clarity regarding for clinicians to choices best surgical approach for patients with cervical disc herniation. Any changes that need to be made during the process of this study will be explained in the final full-text publication.Protocol registration number:CRD42020164011.

The key hole augmentation with demineralized bone matrix in anterior cervical trans-corporeal discectomy – Preliminary result of a novel technique

ObjectiveThe objective of this study was to evaluate the benefit of key hole augmentation with demineralized bone matrix (DBM) when performing the anteriortrans-corporeal discectomy (ACTD) for the treatment of cervical disc herniation. MethodsOf the 44 patients diagnosed with symptomatic cervical disc herniation, 22 patients were surgically treated by ACTD-alone, and the remaining 22were treated using ACTD with keyhole augmentation using DBM. Clinical outcomes were assessed using a visual analog scale (VAS). Plain radiographs were periodically checked during and up to 1 year postoperatively. The changes in the cervical lordosis angle, functional spinal unit angle, disc height, and anterior/posterior body height were serially measured and compared between the two groups. ResultsIn the ACTD-alone group, the disc height, anterior body height, and posterior body height gradually decreased during 1 year postoperatively, from 6.1 ± 1.00 mm to 4.3 ± 0.94 mm, 14.6 ± 1.60 mm to 12.7 ± 2.19 mm, and 14.6 ± 1.72 mm to 13.1 ± 2.23 mm, respectively; in the ACTD with keyhole augmentation group, these values were relatively stable (6.4 ± 1.02 mm to 4.6 ± 0.93 mm, 15.3 ± 1.27 mm to 13.9 ± 1.32 mm, and 15.8 ± 1.30 mm to 14.5 ± 1.32 mm, respectively). Most significant changes occurred 6 months postoperatively (p < 0.05). ConclusionsThis preliminary result of comparative study suggested that key hole augmentation with DBM could be an effective technique to prevent early height loss of the vertebral body and disc after ACTD and provide better biomechanical stability.