Saringer W, Nöbauer I, Reddy M, Tschabitscher M, Horaczek A
Department of Neurosurgery, University of Vienna, Medical School, Vienna, Austria.
Acta Neurochir (Wien). 2002 Jul;144(7):685-94. doi: 10.1007/s00701-002-0953-2.
The authors report the clinical application of a new microsurgical technique. The cervical anterior foraminotomy (uncoforaminotomy), which is used for the surgical treatment of unilateral cervical radiculopathy secondary to posterolateral disc herniations or spondylotic foraminal stenoses.
Between June 2000 and May 2001, 34 patients (16 men and 18 women with a mean age of 43.8 years, range 29 to 80 years) underwent anterior cervical foraminotomy (uncoforaminotomy) for the treatment of cervical radiculopathy at one or two adjacent levels in the Neurosurgical Department of the University of Vienna. This surgical technique was devised to accomplish direct anterior decompression of the affected nerve root by removing an offending posterolateral sponylotic spur or disc fragment. The nerve root is decompressed from its origin in the spinal cord to the point were it passes behind the vertebral artery laterally. The intervertebral disc of the affected level is maintained in its form and function. Thus, the functioning motion segment is preserved and fusion related sequelae, including graft related complications, graft site complications and the adjacent level disease, are avoided. Prior to its clinical application, anatomical features of the anterior cervical spine were reviewed, and an anatomical morphometric analysis and work-up of the technique was performed in 4 cervical specimens.
The follow-up period varied from two to 17 months with a mean of 8.2 months. The large majority (97%) of patients were pleased with the results of their operation. The relief of neck pain and redicular pain in the affected dermatome was immediate in all patients. Motor-weakness and sensory deficit improved dramatically immediately postoperatively, and improved to normalisation in the majority of patients within 3 to 6 months. Two of the patients sustained an incomplete transient recurrent laryngeal nerve palsy, which fully resolved within two to 4 weeks. One of the patients had a repeat herniation on the second postoperative day, but recovered completely after re-operation and continued to do well at the 6-month follow-up. No permanent surgery related morbidity or associated complications were encountered.
The results indicate that this new microsurgical technique is an attractive treatment option for adequate anterior decompression of the cervical nerve root via a minimized approach. It was associated with excellent clinical outcome and a less painful postoperative course, allowing patients an almost immediate return to unrestricted full activity.
作者报告一种新的显微外科技术的临床应用。颈椎前路椎间孔切开术（钩椎关节切开术），用于手术治疗继发于后外侧椎间盘突出或椎间孔狭窄性颈椎病的单侧颈神经根病。
2000年6月至2001年5月期间，34例患者（16例男性和18例女性，平均年龄43.8岁，范围29至80岁）在维也纳大学神经外科接受颈椎前路椎间孔切开术（钩椎关节切开术），以治疗一个或两个相邻节段的颈神经根病。该手术技术旨在通过去除引起病变的后外侧骨质增生或椎间盘碎片来实现对受影响神经根的直接前路减压。神经根从其在脊髓的起源处减压至其在椎动脉外侧后方通过的部位。受影响节段的椎间盘保持其形态和功能。因此，保留了功能运动节段，避免了与融合相关的后遗症，包括移植物相关并发症、移植物部位并发症和相邻节段疾病。在其临床应用之前，回顾了颈椎前路的解剖特征，并在4个颈椎标本上进行了该技术的解剖形态学分析和研究。
随访期为2至17个月，平均8.2个月。绝大多数（97%）患者对手术结果满意。所有患者受影响皮节的颈部疼痛和神经根性疼痛立即缓解。运动无力和感觉障碍在术后立即显著改善，大多数患者在3至6个月内恢复正常。2例患者出现不完全性短暂性喉返神经麻痹，在2至4周内完全恢复。1例患者在术后第二天出现复发性椎间盘突出，但再次手术后完全康复，在6个月随访时情况良好。未遇到与手术相关的永久性发病率或相关并发症。
结果表明，这种新的显微外科技术是一种有吸引力的治疗选择，可通过最小化入路对颈神经根进行充分的前路减压。它具有出色的临床效果和术后疼痛较轻的特点，使患者几乎可以立即恢复不受限制的完全活动。
