Department of Orthopaedic Surgery, Medical College of Hallym University, Pyeongchon-dong, Gyeonggi-do, Republic of Korea.
Spine (Phila Pa 1976). 2013 Jan 15;38(2):112-8. doi: 10.1097/BRS.0b013e318267b0e6.
Case series study.
To report the results of surgical intervention in a series of patients with high cervical radiculopathy.
Although midcervical (C5-C7) radiculopathy is common and well recognized, high cervical (C3 and C4) radiculopathy is relatively rare and can be missed clinically. To our knowledge, there are few reports regarding the operative treatment of high cervical radiculopathy.
Two spine surgeons independently reviewed the charts and radiographs of all patients with high cervical radiculopathy or myeloradiculopathy that were surgically treated by the senior author. Dates of inclusion were from July 1997 to March 2008. All patients were observed for either a minimum of 2 years or until they achieved a fusion. Neck Disability Index scores were calculated pre- and postoperatively, when available, and Odom criteria were assessed for all patients.
Twenty-three patients met the inclusion criteria. The mean follow-up period was 4.2 years (1-11.3 yr). The levels involved were C2-C3 (2 patients), C2-C4 (4 patients), and C3-C4 (17 patients). The most common symptom was suboccipital neck pain/headache with or without radiation to the retroauricular or retro-orbital region (21 patients). Preoperative neuroradiological findings were central stenosis with herniated nucleus pulposus, foraminal stenosis with uncinate hypertrophy or facet arthrosis, spondylolisthesis, and pseudarthrosis. Operative treatments included anterior cervical discectomy and fusion, posterior foraminotomy, posterior laminectomy-foraminotomy with fusion, posterior laminoplasty with fusion, and anterior/posterior combined decompression and fusion. By Odom criteria, 12 had excellent results, 8 had good results, 2 had satisfactory results, and 1 had a poor result. One patient underwent a reoperation for pseudarthrosis.
Surgical treatment of high cervical radiculopathies resulted in acceptable outcomes. To our knowledge, this is the largest series of this relatively rare condition.
病例系列研究。
报告一系列高位颈椎神经根病患者的手术干预结果。
虽然颈中段（C5-C7）神经根病很常见且已得到广泛认识，但高位颈椎（C3 和 C4）神经根病相对少见，临床上可能会被漏诊。据我们所知，关于高位颈椎神经根病的手术治疗报道较少。
两位脊柱外科医生独立审查了由资深作者手术治疗的所有高位颈椎神经根病或脊神经根病患者的病历和影像学资料。纳入的时间范围为 1997 年 7 月至 2008 年 3 月。所有患者均观察至少 2 年或直至融合。在有条件的情况下，计算术前和术后的颈椎残障指数（NDI）评分，并评估所有患者的 Odom 标准。
23 名患者符合纳入标准。平均随访时间为 4.2 年（1-11.3 年）。受累的节段为 C2-C3（2 例）、C2-C4（4 例）和 C3-C4（17 例）。最常见的症状是枕下颈部疼痛/头痛，伴有或不伴有向耳后或眼眶后放射（21 例）。术前神经放射学发现为中央狭窄伴椎间盘突出、侧隐窝狭窄伴钩突肥大或小关节突关节炎、脊椎滑脱和假关节。手术治疗包括前路颈椎间盘切除融合术、后路椎间孔切开术、后路椎板切开术-椎间孔切开术融合术、后路椎板成形术融合术以及前路/后路联合减压融合术。根据 Odom 标准，12 例患者的结果为优，8 例为良，2 例为可，1 例为差。1 例患者因假关节而行再次手术。
手术治疗高位颈椎神经根病可获得可接受的结果。据我们所知，这是此类相对罕见疾病的最大系列研究。
