Objective To compare and analyze the short-term efficacy of percutaneous posterior full-endoscopic key-hole surgery and anterior cervical discectomy and fusion(ACDF) in the treatment of cervical radiculopathy(CR)，and to explore the choice of treatment scheme for CR.Methods A retrospective analysis was conducted on the data of 52 CR patients who underwent surgical treatment at Beijing Electric Power Hospital from April 2019 to April 2021.In endoscopic group，25 patients underwent percutaneous posterior full-endoscopic key-hole surgery.This group included 14 males and 11 females，with an average age of (46.61±9.23) years.In fusion group，27 cases were treated with ACDF.This group included 14 males and 13 females，with an average age of (52.32±9.05) years.Visual analog scale Japanese orthopaedic association(JOA)，neck disability index(NDI) evaluations，physiological curvature measurement of the cervical spine at the last follow-up and modified MacNab efficacy evaluation were used to evaluate the surgical efficacy.Results Both groups of patients successfully completed the surgery，with a surgical time of (73.23±7.61) min in the endoscopic group and (75.28±8.49) min in the fusion group.The hospitalization time and recovery time of the endoscopic group were shorter than those of the fusion group.At 3 days，3 months，6 months，and 12 months after surgery，the neck VAS scores in the endoscopic group and fusion group were significantly lower than those before surgery (P＜0.001).At 3 days after surgery，the neck VAS scores in the endoscopic group were significantly lower than those in the fusion group (P＜0.05).There was no statistically significant difference in the neck VAS scores between the two groups at 3，6 and 12 months after surgery (P＞0.05).The NDI scores at 3 days，3 months，6 months and 12 months after surgery in both groups were significantly lower than those before surgery (P＜0.001).There was no statistically significant difference in NDI scores between the two groups (P＞0.05).At 3，6 and 12 months after surgery，the JOA scores of the two groups increased compared to those before surgery (P＜0.05).There was no statistically significant difference in JOA scores between the two groups (P＞0.05).The evaluation results of the improved MacNab efficacy in the endoscopic group were excellent in 15 cases，good in 7 cases，fair in 2 cases，and poor in 1 case，with an excellent and good rate of 88.00%.The evaluation results of the improved MacNab in the fusion group were excellent in 17 cases，good in 8 cases，and fair in 2 cases，with an excellent and good rate of 92.59%.Conclusion Percutaneous posterior endoscopic key-hole surgery and traditional ACDF can both achieve good results in the treatment of CR.Both methods can be selected.The elderly patients who cannot tolerate general anesthesia are more recommended to consider percutaneous posterior endoscopic spinal surgery.

Objective To compare the clinical efficacy of extrapedicular unilateral percutaneous kyphoplasty(PKP) via the upper edge of the transverse process with that of traditional pedicle approach for the treatment of type II osteoporotic vertebral compression fracture with vertebral pedicle stenosis in the upper lumbar spine.Methods A prospective study was performed on the patients with II osteoporotic vertebral compression fractures of upper lumbar with pedicle stenosis treated from December 2020 to December 2021.According to random number table，the patients were divided into group A (treated with extrapedicular unilateral PKP via the upper edge of transverse process approach，68 cases) and group B (treated with unilateral PKP via transpedicle approach，67 cases).There were 25 males and 43 females in group A，aged from 60 to 89 years，with an average age of (70.40±6.95) years.In group B，there were 21 males and 46 females，aged from 60 to 85 years，with an average age of (73.02±8.51) years.The operation time，fluoroscopy frequency，bone cement injection volume，and bone cement dispersion were recorded.And the visual analogue scale(VAS)，Oswestry disability index(ODI) score，anterior height(AH)，and kyphotic angle(KA) 〖JP2〗of the injured vertebrae in each group were compared before and after surgery.Results All patients completed surgery successfully，41 patients lost follow-up due to irregular follow-up or incomplete imaging data，and 94 patients completed final follow-up for 11~14 months，with an average of (12.53±0.84) months.Three patients in group B developed compression fractures of the adjacent vertebrae.None of the patients had intraoperative infection，pulmonary embolism and other complications.VAS and ODI scores in 2 groups were significantly improved after surgery compared with before surgery，and the difference between 2 groups was statistically significant (P＜0.05).The AH and KA of the injured vertebrae in both groups were significantly improved at 1 day after operation，and the AH and KA of the injured vertebrae in group A were (22.12±0.58) mm and (14.32±0.40) °，which were better than those in group B (21.57±0.65) mm and (14.49±0.34)°，the differences were statistically significant (P＜0.05).The bone cement injection and the contralor distribution rate of bone cement in group A were (6.45±0.35) mL and (58.10±4.11)%，respectively，which were better than those in group B (5.29±0.48) mL and (25.82±3.92)%.Conclusion Compared with the traditional transpedicle approach，the extrapedicle approach via the upper edge of the transverse process has little difference in early postoperative imaging，however，it has significant effect on improving the degree of bone cement diffusion distribution on the contralateral side of the vertebral body and improving early postoperative pain while taking into account surgical safety.

Objective To investigate the clinical effect of tranexamic acid (TXA) in posterior lumbar interbody fusion (PLIF)，analyze the main factors of the bleeding of PLIF，and provide a basis for individualized medication.Methods A total of 140 patients who underwent PLIF in our hospital from August 2021 to April 2022 were prospectively analyzed.Six patients were excluded and the remaining 134 patients were divided into two groups by randomization software.Patients in experimental group were intravenously injected with TXA 1 g 15 min before skin resection.Patients in control group were intravenously infusion with the same amount of normal saline 15 min before skin resection.Finally，130 patients were included in the final analysis.There were 66 cases in the experimental group，including 28 males and 38 females.The patients aged between 41~77 years，with an average age of (60.45±9.18) years.There were 64 cases in the control group，including 29 males and 35 females.The patients aged between 41~77 years，with an average age of (59.69±9.08) years.The blood loss，blood transfusion rate，incidence of thrombotic events and inflammatory index levels were compared between the two groups.Multiple regression analysis and stratified analysis were used to explore the factors affecting PLIF blood loss.Results The blood loss and blood transfusion rate in the experimental group were lower than those in the control group (P＜0.05).The level of C-reactive protein in the experimental group was lower than the control group，and the level of albumin was higher than the control group 24h after surgery (P＜0.05).There were no complications such as deep vein thrombosis，pulmonary embolism，and myocardial infarction in both groups.Multiple regression analysis showed that the preoperative application of TXA，gender，operation time，screw number，smoke history，incision length，blood transfusion，preoperative FIB，and preoperative Alb were the main factors which affect the total blood loss.Conclusion Preoperative application of TXA can reduce perioperative blood loss of PLIF without increasing the risk of postoperative thrombosis.Gender，operation time，screw number，smoke，incision length，blood transfusion，and preoperative FIB and Alb are the main factors affecting total blood loss.For patients with multiple surgical segments，long expected operation time，rich muscle in the lower back，low preoperative FIB，and smoke history.It is recommended to routinely use TXA before surgery.