ABSTRACT
Objective:To investigate the clinical efficacy of full-endoscopic technique through the posterior cervical Delta large portal for the treatment of cervical spondylotic myelopathy and radiculopathy.Methods:The clinical data were analyzed retrospectively of the 15 patients who had been treated for cervical spondylotic myelopathy or radiculopathy at Orthopedics Department, Jiaxing Xiuzhou District People's Hospital from January 2020 to June 2021. There were 6 males and 9 females, aged from 54 to 76 years (average, 66.2 years). Responsible levels: 3 cases of C3, 4, 4 cases of C4, 5, 7 cases of C5, 6 and 1 case of C6, 7. They were all treated by full-endoscopic technique through the posterior cervical Delta large portal. The therapeutic efficacy was assessed by comparing the neck disability indexes (NDI) and Japanese Orthopaedic Association (JOA) cervical scores at preoperation, 1 and 3 months post-operation, and the last follow-up, and the modified MacNab scores at the last follow-up. The operative effects on cervical curvature and segmental stability were assessed by comparing the C2-7 cobb angles and operative ranges of motion (ROM) at preoperation, 1 and 3 months postoperation, and the last follow-up.Results:All cases completed their operation successfully. The operation time ranged from 56 to 82 min (average, 65.7 min), and the intraoperative blood loss from 10 to 30 mL (average, 20.7 mL). Tissue infection, intraspinal infection, dural tear, nerve root injury or perioperative anesthesia-related complications occurred in none of the patients. All patients were followed up for 6 to 18 months (average 10.8 months). The NDIs at 1 and 3 months post-operation, and the last follow-up (18.54%±3.06%, 14.96%±2.33%, and 12.89%±2.33%) were significantly lower than that before operation (34.19%±3.83%), and those at 3 months postoperation and the last follow-up significantly lower than that at 1 month postoperation ( P<0.05), but there was no significant difference between 3 months postoperation and the last follow-up in NDI ( P>0.05). The JOA scores at 1 and 3 months postoperation, and the last follow-up [(12.28±1.65), (13.30±1.57) and (13.54±1.41) points] were significantly higher than the preoperative value [(9.25±1.49) points] ( P<0.05), but there was no such a significant difference between postoperative time points ( P>0.05). Comparisons between preoperation, 1 and 3 months postoperation, and the last follow-up showed no significant difference in the C2-7 cobb angle or operative ROM ( P>0.05). The modified MacNab scores at the last follow-up resulted in 9 excellent, 5 good and 1 fair cases. Conclusion:In the treatment of cervical spondylotic myelopathy and radiculopathy, the full-endoscopic technique through the posterior cervical Delta large portal shows the advantages of limited invasion and complications, rapid recovery after operation, and little impact on the cervical curvature and segmental stability.
ABSTRACT
Objective To explore the risk factors of aseptic meningitis (AM) after microvascular decompression (MVD) to provide evidence for preventing the occurrence of AM. Methods One hundred and forty-one patients diagnosed as having trigeminal neuralgia or hemifacial spasm, admitted to our hospital from January 2014 to December 2016, were chosen. A retrospective analysis was performed on these clinical data. Eighteen related factors of AM were analyzed by Logistic regression model. Results The result of single analysis of related factors showed that gender, age, diabetes, operation time, skill level of the operator, injection of dexamethasone, and postoperative dressing time were related to AM after MVD (P<0.05). Multifactor Logistic regression analysis showed that gender (OR=2.920, P=0.015), diabetes (OR=0.200, P=0.026), and non-injection of dexamethasone (OR=7.970, P=0.002) were independent risk factors of postoperative AM. Conclusion The male or diabetic patients have high rate of postoperative AM; and the risk of postoperative AM would be reduced if we inject dexamethasone to the cerebellopontine angle cistern at the end of MVD.