Ultrasonic Total Uncinectomy: A Novel Technique for Complete Anterior Decompression of Cervical Nerve Roots
Ultrasonic Total Uncinectomy: A Novel Technique for Complete Anterior Decompression of Cervical Nerve Roots
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DOI：
10.1227/neu.0000000000000549
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发表时间：
2014-12-01
影响因子：
2.3
通讯作者：
Pakzaban, Peyman
中科院分区：
文献类型：
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作者：
Pakzaban, Peyman
背景：在标准的颈前盘切除术中，由于有损伤椎动脉的风险，通常不尝试完全切除钩突。当有严重的骨间孔狭窄时，这可能导致神经根不完全减压。目的：探讨超声解骨术治疗伴有中央和椎间孔狭窄需要前路减压融合的患者全椎突切除术的可行性。方法：介绍了一组颈椎神经根病或髓根病患者行单节段或多节段超声全椎间盘切除术（UTU）联合颈前盘切除术和融合术的病例。用超声骨解剖器沿其基部切除钩状突，整体切除以暴露颈椎根和椎动脉。根据常规做法收集的资料进行回顾性分析。结果：38例患者共切除钩突44个。无一例UTU手术因技术困难而流产，无椎动脉或神经根损伤发生。平均随访28周（14-37周）。颈部和手臂疼痛的平均颈部残疾指数和视觉模拟量表评分分别从42%、4.9%和6.8%提高到23%、2.6%和2.1%。术后计算机断层扫描和斜位x线片显示UTU后神经孔完全减压。结论：UTU是一种安全有效的颈神经根完全减压技术，当中央和椎间孔病理共存时需要前路入路。详细叙述了手术技术。
BACKGROUND: In standard anterior cervical diskectomy, complete resection of the uncinate process is not commonly attempted because of the risk of injury to the vertebral artery. This may result in incomplete decompression of the nerve root when there is severe osseous foraminal stenosis.OBJECTIVE: To demonstrate the feasibility of total uncinectomy with an ultrasonic bone dissector in patients with concomitant central and foraminal stenosis requiring anterior decompression and fusion.METHODS: A case series of patients with cervical radiculopathy or myeloradiculopathy who underwent single-level or multilevel ultrasonic total uncinectomy (UTU) in combination with anterior cervical diskectomy and fusion is presented. The uncinate process was amputated along its base with an ultrasonic bone dissector and removed en bloc to expose the cervical root and the vertebral artery. Data gathered in accordance with routine practice were analyzed retrospectively.RESULTS: Forty-four uncinate processes were resected in 38 patients. No UTU procedures were aborted because of technical difficulties, and no vertebral artery or nerve root injury occurred. Mean follow-up was 28 weeks (range, 14-37 weeks). Mean Neck Disability Index and Visual Analog Scale scores for neck and arm pain improved from 42%, 4.9%, and 6.8% to 23%, 2.6%, and 2.1%, respectively. Postoperative computed tomography and oblique radiographs revealed complete decompression of the neural foramen after UTU.CONCLUSION: UTU is a safe and effective technique for complete decompression of cervical nerve roots when the coexistence of central and foraminal pathology dictates an anterior approach. The surgical technique is described in detail.