Clinical and radiographic changes after percutaneous endoscopic cervical discectomy: a long-term follow-up.
OBJECTIVE
Results following anterior cervical discectomy (ACD) without fusion are not well reported because of skepticism that the disturbed cervical spine anatomy after ACD might compromise clinical outcome. The purpose of this study was to determine whether ACD without fusion prompts the degenerative process significantly, and whether it is necessary to preserve disc height and cervical alignment for the sake of better clinical outcome following cervical spine surgery.


BACKGROUND
Out of 56 consecutive patients, 37 patients who replied and consequently underwent postoperative MRI from April to June 2009 were included in this study.


METHODS
A total of 37 consecutive patients diagnosed as having cervical monoradiculopathy and treated with percutaneous endoscopic cervical discectomy (PECD) were investigated. Angle of cervical lordosis, change in cervical range of motion, disc height change, and degree of degenerative changes at the corresponding level were evaluated. The visual analogue scale (VAS) score for neck and arm pain and the neck disability index (NDI) were compared preoperatively and at the final follow-up. The mean follow-up period was 45.5 months.


RESULTS
Despite prompted radiological deterioration such as loss of disc height (the posterior disc heights and central disc height ratio were significantly decreased from 3.6 to 2.6 mm, from 30.3% to 24.5%, respectively, p<0.05) or degenerative progression (from average grade of 2.8 to 4.1, p<0.05), the patients achieved significant improvement in clinical outcomes (VAS for neck and arm dropped from mean 6.3 and 7.5 to 2.7 and 2.6, respectively, and NDI score improved from 46.8% to 17.2%, p<0.05) after PECD.


CONCLUSIONS
Neither loss of disc height nor progression of degeneration at disc space compromised clinical outcome after PECD without fusion on long-term follow-up.
Department of Neurosurgery, Wooridul Spine Hospital , Seoul, South Korea .
June Ho
JH
Lee
Sang-Ho
SH
Lee
D002574:Cervical Vertebrae / Q000601:surgery*; D017587:Diskectomy, Percutaneous / Q000379:methods*; D004724:Endoscopy / Q000379:methods*; D005260:Female; D005471:Fluoroscopy; D005500:Follow-Up Studies; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D007405:Intervertebral Disc Displacement / Q000145:classification / Q000601:surgery*; D008279:Magnetic Resonance Imaging; D008297:Male; D010147:Pain Measurement; D011843:Radiculopathy / Q000145:classification / Q000601:surgery*; D016896:Treatment Outcome