Hesham Magdi Soliman1. 1. From the Faculty of Medicine, Cairo University, Abd Elaziz Alseoud, Manial-Roda, Cairo, Egypt.
Abstract
STUDY DESIGN: A blinded randomized controlled trial. OBJECTIVE: The purpose of this study was to evaluate the cervical microendoscopic discectomy and fusion. SUMMARY OF BACKGROUND DATA: Minimally invasive treatment of spinal disorders allows surgeons to have direct access to the pathology with a reduced surgical morbidity, which is reflected over the improved postoperative course. Minimally invasive techniques for cervical discectomy including the posterior microendoscopic discectomy and the percutaneous endoscopic discectomy have a high success rate but are limited by the narrow range of indications. Lately, preliminary reports about cervical microendoscopic discectomy and fusion (CMEDF) showed high success rates without restrictions in the indications. METHODS:Seventy consecutive patients were randomly assigned in 2 equal groups, the first operated by the "gold standard" anterior cervical discectomy and fusion and the second by CMEDF. Blinding included the patient-until dressing removal, the evaluating physician, and the radiologist throughout the entire study. The mean follow-up period was 28 months and outcome has been assessed using the Japanese Orthopaedic Association score, Odom criteria and the visual analogue scale. In addition, the operative time, complication rate, hospitalization, and the postoperative analgesic doses were recorded. RESULTS: The functional outcome of the CMEDF at the final follow-up was 91% good to excellent. Results in the open group were very similar. Meanwhile, CMEDF demonstrated improved cosmesis, reduced laryngopharyngeal complication rate, postoperative analgesics, and hospital stay. CONCLUSION: The results of the CMEDF are very promising. However, a much larger patient series from multicenter studies is still required for drawing up a final conclusion. LEVEL OF EVIDENCE: 1.
RCT Entities:
STUDY DESIGN: A blinded randomized controlled trial. OBJECTIVE: The purpose of this study was to evaluate the cervical microendoscopic discectomy and fusion. SUMMARY OF BACKGROUND DATA: Minimally invasive treatment of spinal disorders allows surgeons to have direct access to the pathology with a reduced surgical morbidity, which is reflected over the improved postoperative course. Minimally invasive techniques for cervical discectomy including the posterior microendoscopic discectomy and the percutaneous endoscopic discectomy have a high success rate but are limited by the narrow range of indications. Lately, preliminary reports about cervical microendoscopic discectomy and fusion (CMEDF) showed high success rates without restrictions in the indications. METHODS: Seventy consecutive patients were randomly assigned in 2 equal groups, the first operated by the "gold standard" anterior cervical discectomy and fusion and the second by CMEDF. Blinding included the patient-until dressing removal, the evaluating physician, and the radiologist throughout the entire study. The mean follow-up period was 28 months and outcome has been assessed using the Japanese Orthopaedic Association score, Odom criteria and the visual analogue scale. In addition, the operative time, complication rate, hospitalization, and the postoperative analgesic doses were recorded. RESULTS: The functional outcome of the CMEDF at the final follow-up was 91% good to excellent. Results in the open group were very similar. Meanwhile, CMEDF demonstrated improved cosmesis, reduced laryngopharyngeal complication rate, postoperative analgesics, and hospital stay. CONCLUSION: The results of the CMEDF are very promising. However, a much larger patient series from multicenter studies is still required for drawing up a final conclusion. LEVEL OF EVIDENCE: 1.