頸部前膜および/または側方脊柱管狭窄症を原因とする頸部脊椎症性橈骨症を対象とした後頸部経皮内視鏡的腹側骨減圧療法と単純背側骨減圧療法の比較検討：臨床レトロスペクティブ研究

A comparison study of posterior cervical percutaneous endoscopic ventral bony decompression and simple dorsal decompression treatment in cervical spondylotic radiculopathy caused by cervical foraminal and/or lateral spinal stenosis: a clinical retrospective study.

• Yuexin Tong
• Zhangheng Huang
• Chuan Hu
• Zhiyi Fan
• Fucheng Bian
• Fengkai Yang
• Chengliang Zhao

抄録

背景:

経皮的内視鏡的頸部減圧術（PECD）は、頸部脊椎症性橈骨症（CSR）の治療に理想的な低侵襲減圧術式である。しかし、背骨の切除と遊離髄核の除去が主流となっている。議論すべき頚椎前骨および/または側方脊柱管狭窄症(CFa/oLSS)に起因するCSRの治療における腹側骨棘細胞や過形成靭帯の切除の必要性。

BACKGROUND: Percutaneous endoscopic cervical decompression (PECD) is an ideal minimally invasive decompression technique for the treatment of cervical spondylotic radiculopathy (CSR). However, the mainstream is the resection of dorsal bone and removal of free nucleus pulposus. The necessity of excision of ventral osteophytes and hyperplastic ligaments in the treatment of CSR caused by cervical foraminal and/or lateral spinal stenosis (CFa/oLSS) to be discussed.

方法:

2017年1月から2018年11月までにCFA/oLSSを原因とするCSRを発症した46例を対象にレトロスペクティブ研究を行った。これらの患者には、後経皮的内視鏡的頸部減圧-背骨減圧術（PPECD-VBD）（23例、VBD群に分類）または後経皮的内視鏡的頸部減圧-単純背骨減圧術（PPECD-SDD）（23例、SDD群に分類）を施行した。手術後、Visual Analogue Scale (VAS)、Neck Disable Index (NDI)、Japanese"Zs_2002"Orthopaedic"Zs_2002"Association (JOA)スコア、ミオダミアを記録した。さらに、VBD群の頸椎曲率と頸椎運動の変化を評価し、各患者のフォローアップ期間中の手術時間と合併症を記録した。

METHODS: We performed a retrospective study of 46 patients with CSR caused by CFa/oLSS from January 2017 to November 2018. These patients received posterior percutaneous endoscopic cervical decompression-ventral bony decompression (PPECD-VBD)(23 cases, classified as VBD group) or posterior percutaneous endoscopic cervical decompression-simple dorsal decompression (PPECD-SDD)(23 cases, classified as SDD group). Following surgery, we recorded Visual Analogue Scale (VAS), Neck Disable Index (NDI), Japanese Orthopaedic Association (JOA) Scores and myodynamia. We further evaluated the changes of cervical curvature and cervical spine motion in the VBD group and recorded the operation time and complications during the follow-up of each patient.

結果:

すべての患者が手術を成功させ、平均追跡期間は16.53±9.90monthsであった。VBD群の優秀率は91.29%、SDD群の良好率は60.87%であった。SDD群では、術後1day、6months、12monthsの時点で頚部-VAS、腕部-VAS、NDIスコアがVDD群に比べて有意に高く（P＜0.05）、JOAスコア、JOA改善率はVDD群に比べて有意に低かった（P＜0.05）。角変位(AD)、水平変位(HD)、セグメント角度(SA)、頚椎曲率(CA)については、VBD群では術前と術後で有意差はなかった(P>0.05)。

RESULTS: All patients underwent successful operations, with an average follow-up time of 16.53 ± 9.90 months. The excellent and good rates in the VBD and SDD groups were 91.29 and 60.87%, respectively. In the SDD group, neck-VAS, arm-VAS, and NDI scores were significantly higher than those of the VBD group at 1 day, 6 months, and 12 months after surgery (P < 0.05), while the JOA scores and improvement rate of JOA were significantly lower than those of the VBD group (P < 0.05). There were no significant differences in terms of angular displacement (AD), horizontal displacement (HD), segmental angle (SA) and cervical curvature (CA) before and after the operation in the VBD group (P > 0.05).

結論:

PPECD-VBDはPPECD-SDDよりも有意に優れており、PPECD-VBDは頸椎の安定性や湾曲に有意な影響を与えなかった。

CONCLUSION: PPECD-VBD was significantly better than PPECD-SDD as well as PPECD-VBD had no significant effects on cervical spine stability or cervical curvature.