[Comparison of clinical effects of different anterior surgical methods for the treatment of single segment cervical disc herniation]

Objective: To compare the clinical effects of different anterior surgical methods in treating single segment cervical disc herniation.

Methods: The clinical data of 46 patients with single-segment cervical disc herniation underwent surgical treatment from September 2013 to September 2018 were retrospectively analyzed. The patients were divided into three groups according to different surgical methods. Among them, 23 patients in the anterior percutanousendomic cervical dissection (APECD) group, there were 8 males and 15 females, aged (47±3) years old, prominent segments were C_3,4 of 1 case, C_4,5 of 6 cases, and C_5,6 of 16 cases;10 patients in cervical disc replacement(CDR) group, there were 4 males and 6 females, aged (46± 3) years old, prominent segments were C_3,4 of 1 case, C_4,5 of 6 cases, C_5,6 of 3 cases;13 patients in transcervical anterior cervical disc fusion (ACDF) group, there were 8 males and 5 females, aged (53±2) years old, protruding segments were C_3,4 of 1 case, C_4,5 of 3 cases, C_5,6 of 9 cases. The operation time, intraoperative blood loss, and length of hospitalization were compared among three groups;visual analogue scale (VAS) and Japanese Orthopaedic Association(JOA) score were used to evaluate the clinical efficacy.

Results: All 46 patients were followed up for 12 to 24 (17.57±3.15)months. The follow-up time of APECD, CDR, ACDF groups were (17.30±3.25), (17.80±3.16), (17.85±2.88) months, and operation time were (95.48 ±13.85), (58.50±7.09), (76.00±15.72) min, respectively, there were no significant differences in follow-up time and operation time between two groups(P>0.05). The intraoperative blood loss of APECD, CDR, ACDF groups were (80.00±20.22), (82.60±7.20), (121.54±18.75) ml, there was significant difference between CDR group and ACDF group (P<0.05);and there was no significant difference between other groups (P>0.05). The length of hospitalization was (6.95±1.50) days in APECD group, (6.60± 0.80) days in CDR group, (6.54±0.75) days in ACDF group, and there was no significant difference between two groups (P> 0.05). At the latest follow up, VAS scores were decreasedfrom preoperative 6.78±0.83 to 2.57±0.65 in APECD group, decreased from 5.70±0.78 to 2.00±0.45 in CDR group, decreased from 6.77±0.42 to 1.38±0.49 in ACDF group. The JOA scores at final follow-up were increased from 8.91±0.97 to 13.04±1.40 in APECD group, and the improvement rate of (65±15)%;increased from 11.50±1.20 to 14.90±1.14 in CDR group, and the improvement rate of (76±19)%;increased from 8.54±0.93 to 14.00±0.96 in ACDF group, and the improvement rate of (74±8)%;there was significant difference in improvement rate between APECD group and CDR group (P<0.05). At final follow-up, the activities of the responsible segment in APECD group and CDR group were well preserved and improved (P<0.05). In the APECD group, the symptoms of two cases recurred during the mid-term follow-up (4 months and 6 months after surgery), one of which improved after strictly conservative treatment;the other one received ACDF surgery a second time, and the postoperative follow-up effect was satisfactory.

Conclusion: The three anterior surgical approaches can achieve satisfactory clinical results for the treatment of single-segment cervical disc herniation. However, the improvement rate of the CDR group and the activity of the retained responsibility segment are better than those of the other two groups. APECD surgery may have recurrence.