Early efficacy and safety of spinal endoscopy assisted anterior cervical discectomy and fusion in the treatment of cervical spondylotic myelopathy.

Purpose To introduce a new surgical approach for spinal endoscopy assisted anterior cervical discectomy and fusion (Endo-ACDF) in treating cervical spondylotic myelopathy (CSM) and to report the clinical results after a 2-year follow-up.

Methods The clinical data of 123 CSM patients who underwent ACDF from February 2020 to February 2022 were retrospectively analyzed. They were divided into two groups: Open-ACDF and Endo-ACDF, based on different surgical methods. Baseline data, hospitalization duration, operation time, intraoperative blood loss, postoperative drainage, and postoperative Japanese orthopedic association (JOA) score, neck disability index (NDI), visual analogue scale (VAS) scores and imaging results were compared between the two groups.

Results There was no statistically significant difference between the baseline data of the two groups (P > 0.05). The intraoperative estimated blood loss and postoperative drainage in the Endo-ACDF group were less than those in the Open-ACDF group (P < 0.05). The postoperative JOA score, NDI, VAS, height of the adjacent vertebral body (HAVB), and cervical lordosis angle (CLA) in both groups were significantly improved compared to the preoperative period, with statistically significant differences (P < 0.05). Compared with the Open-ACDF group, postoperative CLA and HAVB were significantly improved in the Endo-ACDF group, with better clinical outcomes at 1 year postoperatively (P < 0.05). At the last follow-up, HAVB remained higher in the Endo-ACDF group (P < 0.05), but there was no difference in CLA between the two groups (P > 0.05).

Conclusion Endo-ACDF combines the endoscopic system with ACDF technology for treating CSM, demonstrating clinical efficacy comparable to Open-ACDF. Compared to Open-ACDF, Endo-ACDF offers a clearer surgical field, improved intraoperative hemostasis, and reduced intraoperative blood loss and postoperative drainage.