经皮脊柱内镜治疗神经根型颈椎病的 研究进展

Research Progress on Percutaneous Endoscopic Treatment for Radicular Cervical Spondylosis

摘要: 神经根型颈椎病是颈椎退变性疾病中的常见类型，主要由椎间盘突出、钩椎关节增生、骨赘形成及椎间孔狭窄等因素导致颈神经根受压或炎性刺激，表现为颈肩痛、上肢放射痛、麻木及肌力减退。传统前路颈椎间盘切除融合术减压效果确切，但存在节段活动度丧失、邻近节段退变及吞咽困难等不足。近年来，经皮脊柱内镜技术逐渐应用于该病治疗，其通过小切口建立操作通道，在内镜直视下完成突出椎间盘摘除、椎间孔扩大及神经根松解，具有组织损伤小、出血少、术后恢复快、住院时间短及保留颈椎运动节段等优势。目前，前路、后路及双通道内镜技术均已在临床开展，其中后路内镜椎间孔成形术更适用于单侧神经根受压、外侧型椎间盘突出及椎间孔狭窄患者。现有研究表明，经皮脊柱内镜可有效缓解疼痛、改善颈椎功能，并具有较好的中短期安全性。然而，其疗效仍受适应证把握、术者经验、减压范围及并发症防控等因素影响。今后仍需依托多中心、大样本及长期随访研究，进一步明确其远期疗效、安全性及规范化应用价值。

Abstract: Cervical spondylotic radiculopathy represents one of the most prevalent forms of degenerative cervical spine disorders. It commonly arises from mechanical compression or inflammatory irritation of the cervical nerve roots secondary to disc herniation, uncovertebral joint hypertrophy, osteophyte formation, or narrowing of the intervertebral foramen. Patients typically present with neck and shoulder pain, radiating upper-limb pain, sensory disturbances, and varying degrees of motor weakness. Although anterior cervical discectomy and fusion remains an established surgical option with reliable decompressive efficacy, its inherent drawbacks, including loss of segmental motion, accelerated adjacent segment degeneration, and approach-related complications such as dysphagia, have prompted growing interest in motion-preserving and minimally invasive alternatives. Percutaneous spinal endoscopy has increasingly been adopted for the management of cervical spondylotic radiculopathy. By establishing a working channel through a small incision, this technique enables targeted removal of herniated disc fragments, foraminal enlargement, and nerve root decompression under direct endoscopic visualization. Compared with conventional open procedures, it is associated with less soft-tissue disruption, reduced blood loss, faster postoperative recovery, shorter hospitalization, and preservation of cervical segmental mobility. Various endoscopic approaches, including anterior, posterior, and biportal techniques, have been applied in clinical practice. Among these, posterior endoscopic foraminoplasty appears particularly suitable for patients with unilateral radicular compression, lateral cervical disc herniation, or foraminal stenosis. Accumulating clinical evidence indicates that percutaneous spinal endoscopy can achieve meaningful pain relief and functional improvement in appropriately selected patients, with an acceptable short- to mid-term safety profile. Nevertheless, its outcomes are closely related to strict indication selection, surgeon experience, adequacy of decompression, and effective prevention of procedure-related complications. Further well-designed multicenter studies with larger cohorts and extended follow-up periods are needed to determine its long-term efficacy, safety, and role in standardized treatment strategies for cervical spondylotic radiculopathy.