Clinical Efficacy of Endoscopy-Assisted Anterior Cervical Discectomy and Fusion for Single-Segment Cervical Spondylotic Myelopathy: A Retrospective, Propensity Score-Matched Study.

PURPOSE: Endoscopy-assisted anterior cervical discectomy and fusion (EA-ACDF), which integrates the advantages of conventional ACDF and spinal endoscopy, is an innovative technique for treating cervical spondylotic myelopathy (CSM). We compared the clinical efficacy of EA-ACDF and ACDF for treating patients with single-segment CSM.

METHODS

One-hundred and thirty-six CSM patients were retrospectively included from January 2021 to September 2023, of whom 61 underwent EA-ACDF and 75 underwent ACDF. Propensity score matching (PSM) was conducted to adjust for imbalances in covariates between groups. Then, clinical and imaging outcomes, perioperative data, and complications were compared.

RESULTS

After matching, 108 patients were included and followed for 15-38 months. Compared to the ACDF group, the EA-ACDF group had less intraoperative bleeding volume, less drainage volume, and shorter postoperative hospital stays (P < 0.05). At 7 days and 3 months after the surgery, the visual analog scale (VAS), Japanese Orthopedic Association score (JOA), and neck disability index (NDI) improved more significantly in the EA-ACDF group (P < 0.05). Regarding imaging, intervertebral height index (IHI), C2-7 cervical lordosis (C2-7 CL), and C2-7 range of motion (C2-7 ROM) exhibited no statistical differences between the two groups (P > 0.05). The complication rates between the EA-ACDF (3.7%) and ACDF (14.8%) groups demonstrated statistical differences (P = 0.046).

CONCLUSION

Both EA-ACDF and conventional ACDF for single-segment CSM provide satisfactory clinical efficacy. The EA-ACDF procedure provides a clearer surgical field, causes less trauma, allows faster recovery, and has the potential to reduce the risk of complications.