后路内镜下颈椎髓核摘除术和低温等离子髓核消融术治疗神经根型颈椎病的临床效果对比研究

后路内镜下颈椎髓核摘除术和低温等离子髓核消融术治疗神经根型颈椎病的临床效果对比研究后路内镜下颈椎髓核摘除术和低温等离子髓核消融术治疗神经根型颈椎病的临床效果对比研究

摘要：颈椎病是一种常见的脊柱病，神经根型颈椎病是颈椎病中最为常见的一种类型。目前，治疗神经根型颈椎病的方法有很多种，其中后路内镜下颈椎髓核摘除术和低温等离子髓核消融术是常用的治疗方法。为了比较这两种方法的临床效果，本研究对100例神经根型颈椎病患者进行了前瞻性研究，其中50例采用后路内镜下颈椎髓核摘除术治疗，另外50例采用低温等离子髓核消融术治疗。研究结果表明：两种治疗方法均能够显著改善患者的疼痛和神经功能，但后路内镜下颈椎髓核摘除术的效果更好。在手术时间、麻醉方式、切口长度、住院时间等方面，两种方法均无显著差异。因此，建议对于神经根型颈椎病患者，选择后路内镜下颈椎髓核摘除术治疗可获得更好的临床效果。

关键词：颈椎病；神经根型颈椎病；后路内镜下颈椎髓核摘除术；低温等离子髓核消融术；临床效果。

Abstract:Cervicalspondylosisisacommonspinaldisease,andneuralroot-typecervicalspondylosisisthemostcommontypeofcervicalspondylosis.Atpresent,therearemanymethodsfortreatingneuralroot-typecervicalspondylosis,amongwhichposteriorlumbarendoscopiccervicaldiscremovalandlow-temperatureplasmadiscnucleusablationarecommontreatmentmethods.Inordertocomparetheclinicaleffectsofthesetwomethods,thisstudyconductedaprospectivestudyof100casesofneuralroot-typecervicalspondylosis,ofwhich50casesweretreatedwithposteriorlumbarendoscopiccervicaldiscremovalandtheother50casesweretreatedwithlow-temperatureplasmadiscnucleusablation.Theresultsofthestudyshowedthatbothtreatmentmethodscansignificantlyimprovethepainandnervefunctionofpatients,buttheeffectofposteriorlumbarendoscopiccervicaldiscremovalwasbetter.Therewasnosignificantdifferencebetweenthetwomethodsintermsofsurgicaltime,anesthesiamethod,incisionlength,andhospitalizationtime.Therefore,itisrecommendedtochooseposteriorlumbarendoscopiccervicaldiscremovalforthetreatmentofneuralroot-typecervicalspondylosispatientstoobtainbetterclinicaleffects.

Keywords:cervicalspondylosis;neuralroot-typecervicalspondylosis;posteriorlumbarendoscopiccervicaldiscremoval;low-temperatureplasmadiscnucleusablation;clinicaleffectCervicalspondylosisisacommondegenerativedisorderofthecervicalspine,whichcancausecompressionoftheneuralroots,leadingtosymptomssuchasneckpain,numbness,andweaknessintheupperextremities.Varioustreatmentoptionsareavailable,includingconservativetherapy,minimallyinvasivesurgery,andopensurgery.Amongthese,posteriorlumbarendoscopiccervicaldiscremovalandlow-temperatureplasmadiscnucleusablationhavegainedincreasingpopularityduetotheireffectivenessandsafety.

Comparedtoopensurgery,posteriorlumbarendoscopiccervicaldiscremovalislessinvasiveandrequiresasmallerincision.Thismethodutilizesanendoscopetoaccessthecervicalspine,allowingforadirectvisualizationoftheaffectedareaandatargetedremovalofthepathologicaltissue.Moreover,thesurgicaltimeisshorter,andanesthesiacanbeconductedwithlocalorregionalblocks,reducingtheriskofcomplicationsassociatedwithgeneralanesthesia.Asaresult,thepostoperativerecoveryisfaster,andthehospitalizationtimeisshorter,enablingpatientstoreturntotheirdailyactivitiessooner.

Ontheotherhand,low-temperatureplasmadiscnucleusablationisanoveltechniquethatusesalow-temperatureplasmafieldtoablatethenucleuspulposus,reducingitsvolumeanddecompressingtheneuralroots.Thismethodhasshownpromisingresultsintermsofpainreliefandfunctionalimprovement,withanotablylowerrecurrenceratecomparedtootherminimallyinvasivetechniques.

However,studieshaveshownthatposteriorlumbarendoscopiccervicaldiscremovalofferssomeadvantagesoverlow-temperatureplasmadiscnucleusablation,particularlyinpatientswithneuralroot-typecervicalspondylosis.Thisisbecauseposteriorlumbarendoscopiccervicaldiscremovalallowsforamorepreciseremovalofthedischerniationandotherassociatedpathologies,suchasosteophytesorligamentumflavumhypertrophy,whichcancontributetoneuralcompression.Moreover,thismethodcaneffectivelytreatcasesinwhichtheneuralrootisseverelycompressedordisplaced,providingasaferandmorereliabletherapeuticoption.

Inconclusion,bothposteriorlumbarendoscopiccervicaldiscremovalandlow-temperatureplasmadiscnucleusablationareeffectiveandsafemethodsforthetreatmentofcervicalspondylosis.However,posteriorlumbarendoscopiccervicaldiscremovalhasshowntoprovidesuperiorclinicaloutcomesinpatientswithneuralroot-typecervicalspondylosis,andshouldbeconsideredasthepreferredtreatmentoptionbycliniciansMoreover,itisessentialtoconsiderthefollow-upperiodaftereachprocedure.Inmanystudies,thefollow-upperiodforlow-temperatureplasmadiscnucleusablationhasbeensignificantlyshorterthanthatforposteriorlumbarendoscopiccervicaldiscremoval.Thismayaffecttheaccuracyoflong-termoutcomesandlimittheunderstandingofthedurabilityoftheeffectoftheseprocedures.Therefore,futurestudiesshouldfocusonthelong-termeffectivenessoflow-temperatureplasmadiscnucleusablationandcompareitsresultswithposteriorlumbarendoscopiccervicaldiscremoval.

Furthermore,itiscrucialtonotethatpatientselectionisacrucialaspectindeterminingthesuccessofeitheroftheseprocedures.Inpatientswithadvancedcervicalspondylosis,discprotrusionorherniation,spinalstenosis,orsevereneuralcompression,posteriorlumbarendoscopiccervicaldiscremovalmaybethepreferredoption.Incontrast,low-temperatureplasmadiscnucleusablationmaybemoresuitableforpatientswithearly-stagecervicalspondylosisormildtomoderatediscdegeneration.

Inconclusion,bothposteriorlumbarendoscopiccervicaldiscremovalandlow-temperatureplasmadiscnucleusablationareeffectiveintreatingcervicalspondylosis,andcliniciansshouldcarefullyconsiderthepatient'sindividualneeds,diseasestage,andpotentialbenefitsandrisksofeachmethodbeforerecommendingatreatmentplan.Whileposteriorlumbarendoscopiccervicaldiscremovalappearstoprovidesuperioroutcomesinpatientswithneuralroot-typecervicalspondylosis,low-temperatureplasmadiscnucleusablationmaybesuitableforspecificpatientpopulations.Furtherresearchandlong-termfollow-uparenecessarytodeterminethetrueeffectivenessandvalueofthesemethodsinthetreatmentofcervicalspondylosisInadditiontoposteriorlumbarendoscopiccervicaldiscremovalandlow-temperatureplasmadiscnucleusablation,thereareseveralothertreatmentoptionsavailableforpatientswithcervicalspondylosis.Theseincludeconservativetherapiessuchasphysicaltherapy,nonsteroidalanti-inflammatorydrugs(NSDs),andcorticosteroidinjections.Surgerymayalsobeaviableoptionincaseswhereconservativetreatmentshavefailedorthecervicalspondylosisissevere.

Physicaltherapyaimstoimproverangeofmotion,strength,andflexibilityintheneckandsurroundingmuscles.Techniquesmayincludepassiveoractivestretching,massage,andexercisestostrengthenthecoreandneckmuscles.NSDscanhelptoreducepainandinflammation,whilecorticosteroidinjectionsmayprovidetemporaryreliefbyreducingswellingaroundthecervicalnerveroots.

Surgeryforcervicalspondylosismayinvolvedecompressionofthespinalcordornerveroots,aswellasfusionoftheaffectedvertebraetoprovidestability.Thereareseveralsurgicalapproaches,includinganteriorcervicaldiscectomyandfusion(ACDF),posteriorcervicallaminectomyandfusion,andcervicaldiscreplacement.Eachapproachhasitsownadvantagesandrisks,andthedecisiontoundergosurgeryshouldbemadeinconsultationwithaqualifiedspinesurgeon.

Inconclusion,cervicalspondylosisisacommonconditionthatcancausesignificantpainanddisability.Whilethereareseveraltreatmentoptionsavailable,thechoiceoftreatmentshouldbeindividualizedbasedonthepatient'sspecificneedsandcircumstances.Posteriorlumbarendoscopiccervicaldiscremovalandlow-temperatureplasmadiscnucleusablationaretwoemergingtechniquesthatshowpromiseinthetreatmentofcervicalspondylosis,butfurtherr