Journal Article

Unilateral biportal endoscopic decompression versus anterior cervical decompression and fusion for unilateral cervical radiculopathy or coexisting cervical myelopathy: a prospective, randomized, controlled, noninferiority trial

Chu, Rupeng, Cui, Wei, Han, Xiaofei, Zhuang, Yin, Chen, Wenjin, Sun, Zhenzhong, Zhang, Shujun, Peng, Wei

2024

Overview

Background Cervical spondylosis (CS), including myelopathy and radiculopathy, is the most common degenerative cervical spine disease. This study aims to evaluate the clinical outcomes of unilateral biportal endoscopy (UBE) compared to those of conventional anterior cervical decompression and fusion (ACDF) for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. Methods A prospective, randomized, controlled, noninferiority trial was conducted. The sample consisted of 131 patients who underwent UBE or ACDF was conducted between September 2021 and September 2022. Patients with cervical nerve roots or coexisting spinal cord compression symptoms and imaging-defined unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs were randomized into two groups: a UBE group ( n  = 63) and an ACDF group ( n  = 68). The operative time, blood loss, length of hospital stay after surgery, and perioperative complications were recorded. Preoperative and postoperative modified Japanese Orthopaedic Association (mJOA) scale scores, visual analog scale (VAS) scores, neck disability index (NDI) scores, and recovery rate (RR) of the mJOA were utilized to evaluate clinical outcomes. Results The hospital stay after surgery was significantly shorter in patients treated with UBE than in those treated with ACDF ( p  < 0.05). There were no significant differences in the neck or arm VAS score, NDI score, mJOA score, or mean RR of the mJOA between the two groups ( p  < 0.05). Only mild complications were observed in both groups, with no significant difference ( p  = 0.30). Conclusion UBE can significantly relieve pain and disability without severe complications, and most patients are satisfied with this technique. Consequently, this procedure can be used safely and effectively as an alternative to ACDF for treating unilateral cervical radiculopathy or coexisting cervical myelopathy induced by unilateral cervical herniated discs. Trial registration This study was registered in the Chinese Clinical Trial Registry on 02/08/2023 ( http://www.chictr.org.cn , #ChiCTR2300074273).

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Adult / Aged / Anterior cervical decompression and fusion / Care and treatment / Central nervous system diseases / Cervical myelopathy / Cervical radiculopathy / Cervical Vertebrae - diagnostic imaging / Cervical Vertebrae - surgery / Clinical trials / Comparative analysis / Decompression / Decompression, Surgical - methods / Discectomy / Endoscopy / Endoscopy - methods / Epidemiology / Female / General anesthesia / Humans / Iatrogenesis / Internal Medicine / Intervertebral Disc Displacement - complications / Intervertebral Disc Displacement - surgery / Kyphosis / Magnetic resonance imaging / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Methods / Middle Aged / Neck pain / Nervous system / Orthopedics / Pain / Patient outcomes / Patient satisfaction / Patients / Prospective Studies / Radiculopathy / Radiculopathy - etiology / Radiculopathy - surgery / Rehabilitation / Rheumatology / Spinal cord / Spinal cord compression / Spinal Cord Diseases - diagnostic imaging / Spinal Cord Diseases - surgery / Spinal Fusion - methods / Spinal stenosis / Spine / Spine (cervical) / Spine surgery / Spondylosis / Spondylosis - complications / Spondylosis - diagnostic imaging / Spondylosis - surgery / Sports Medicine / Surgeons / Surgery / Treatment Outcome / Unilateral biportal endoscopy