Partial uncinatectomy combined with anterior cervical discectomy and fusion for the treatment of one-level cervical radiculopathy: analysis of clinical efficacy and sagittal alignment.
Partial uncinatectomy combined with anterior cervical discectomy and fusion for the treatment of one-level cervical radiculopathy: analysis of clinical efficacy and sagittal alignment.
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部分非肠切除术与前宫颈椎间盘切除术和融合一起治疗一级宫颈辐射病：临床功效和矢状比对分析。
DOI：
10.1186/s12891-021-04680-0
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发表时间：
2021-09-12
影响因子：
2.3
通讯作者：
Meng Y
中科院分区：
文献类型：
--
作者：
Abudouaini H;Wu T;Liu H;Wang B;Chen H;Huang C;Hong Y;Meng Y
生物力学研究表明，钩椎关节在一定程度上有助于节段的活动性和稳定性。同时，钩突骨赘是神经根型颈椎病（CSR）的常见原因。对于这些患者，可能需要部分钩突切除术（UT）。然而，在颈椎前路椎间盘切除融合术（ACDF）中部分UT的临床疗效和矢状面对线尚未完全阐明。共纳入了87例在2014年7月至2018年12月期间使用零切迹器械接受单节段ACDF的患者。根据钩椎关节孔部分是否切除或保留，将患者分为ACDF加UT组（n = 37）和ACDF不加UT组（n = 50）。比较两组的围手术期数据、影像学参数、临床结局和并发症。ACDF加UT组和ACDF不加UT组的平均随访时间分别为16.86 ± 5.63和18.36 ± 7.51个月（p > 0.05）。ACDF + UT组的平均术前VAS手臂评分为5.89 ± 1.00，ACDF + UT组为5.18 ± 1.21（p = 0.038）。然而，术后1周和末次随访时的平均VAS手臂评分分别为4.22 ± 0.64、4.06 ± 1.13和1.68 ± 0.71、1.60 ± 0.70（p > 0.05）。我们还发现，ACDF + UT组末次随访时的C2-7 SVA和St-SVA及其变化（末次随访值-术前值）显著高于ACDF + UT组（p < 0.05）。在其他颈椎矢状参数、融合率或并发症（包括吞咽困难、ASD和下沉）方面没有观察到显著差异。我们的研究结果表明，ACDF使用零p植入物，有或没有部分UT都提供了令人满意的临床疗效和可接受的安全性。然而，额外的部分UT可能对颈椎矢状面对线产生负面影响。
Biomechanical studies have demonstrated that uncovertebral joint contributes to segment mobility and stability to a certain extent. Simultaneously, osteophytes arising from the uncinate process are a common cause of cervical spondylotic radiculopathy (CSR). For such patients, partial uncinatectomy (UT) may be required. However, the clinical efficacy and sagittal alignment of partial UT during anterior cervical discectomy and fusion (ACDF) have not been fully elucidated. A total of 87 patients who had undergone single level ACDF using a zero-profile device from July 2014 to December 2018 were included. Based on whether the foraminal part of the uncovertebral joint was resected or preserved, the patients were divided into the ACDF with UT group (n = 37) and the ACDF without UT group (n = 50). Perioperative data, radiographic parameters, clinical outcomes, and complications were compared between the two groups. The mean follow-up was 16.86 ± 5.63 and 18.36 ± 7.51 months in the ACDF with UT group and ACDF without UT group, respectively (p > 0.05). The average preoperative VAS arm score was 5.89 ± 1.00 in the ACDF with UT group and 5.18 ± 1.21 in the ACDF without UT group (p = 0.038). However, the average VAS arm score was 4.22 ± 0.64, 4.06 ± 1.13 and 1.68 ± 0.71, 1.60 ± 0.70 at 1 week post operation and at final follow up, respectively, (p > 0.05). We also found that the C2-7 SVA and St-SVA at the last follow-up and their change (last follow-up value − preoperative value) in the ACDF with UT group were significantly higher than ACDF without UT group (p < 0.05). No marked differences in the other cervical sagittal parameters, fusion rate or complications, including dysphagia, ASD, and subsidence, were observed. Our result indicates that ACDF using a zero-p implant with or without partial UT both provide satisfactory clinical efficacy and acceptable safety. However, additional partial UT may has a negative effect on cervical sagittal alignment.
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影响因子：
4.8
作者：
Bartels, RHMA;Donk, RD;Feuth, T
通讯作者：
Feuth, T
影响因子：
3
作者：
Francke, Eric I.;Demetropoulos, Constantine K.;Herkowitz, Harry N.
通讯作者：
Herkowitz, Harry N.
影响因子：
2.8
作者：
Park, Youn-Kwan;Moon, Hong Joo;Kim, Joo Han
通讯作者：
Kim, Joo Han
影响因子：
2.8
作者：
Clausen, JD;Goel, VK;Scifert, J
通讯作者：
Scifert, J
影响因子：
4.1
作者：
Kettler, A;Wilke, HJ;Claes, L
通讯作者：
Claes, L