Kerry Ghassan, Hammer Alexander, Ruedinger Claus, Ranaie Gholamreza, Steiner Hans-Herbert
a Department of Neurosurgery , Paracelsus Medical University , Nuremberg , Germany.
Br J Neurosurg. 2017 Feb;31(1):39-44. doi: 10.1080/02688697.2016.1206184. Epub 2016 Jul 11.
An unsettled controversy over the appropriate surgical approach in cases of cervical radiculopathy caused by degenerative vertebrae and intervertebral discs is still present. The purpose of this study is to examine the efficacy of microsurgical posterior foraminotomy in the treatment of cervical radiculopathy and to find out whether the underlying pathology (soft disc herniation/spondylosis) is of value in predicting long-term outcome after this procedure.
Patients, who underwent posterior cervical foraminotomy (PCF) at our department between 2006 and 2013 for unilateral mono-segmental lateral soft disc herniation, or spondylosis, or both, were enrolled in this study. Demographic, clinical and surgical data were retrospectively reviewed. The patients were subsequently interviewed by telephone to identify their long-term outcome. The clinical outcomes were evaluated using Odom's criteria. Descriptive statistics were frequencies and percentage of occurrence for categorical variables and mean and range for continuous variables.
One hundred eighty-one patients were included in this study, with a median follow-up of 58 months (mean 43 months, range 12-96 months). The overall re-operation rate was 7.2% (13 patients); 11 patients (6%) for recurrent root symptoms due to recurrent disc herniation (six patients, 3.3%) and re-stenosis (five patients, 2.8%), one patient (0.55%) for wound infection and one patient (0.55%) for postoperative haematoma. Among the eleven patients who underwent re-operation for recurrent root symptoms there was one patient who additionally had persistent cerebrospinal fluid leak and superficial posterior wound infection. There was no significant difference between lateral soft disc herniation and spondylosis in term of re-operation rate. At discharge, excellent or good outcome was achieved in 89% of patients; the long-term success rate was 97.2% using Odom's criteria.
Microsurgical PCF is an effective technique for treating lateral spinal root compression. Proper patient selection is obligatory to achieve the best results.
对于因椎体和椎间盘退变导致的神经根型颈椎病，采用何种合适的手术方法仍存在争议。本研究的目的是探讨显微外科后路椎间孔切开术治疗神经根型颈椎病的疗效，并确定潜在病理（软性椎间盘突出/脊椎病）对预测该手术后长期疗效是否有价值。
纳入2006年至2013年期间在我科因单侧单节段外侧软性椎间盘突出、脊椎病或两者皆有而接受后路颈椎椎间孔切开术（PCF）的患者。对人口统计学、临床和手术数据进行回顾性分析。随后通过电话采访患者以确定其长期疗效。采用奥多姆标准评估临床疗效。描述性统计包括分类变量的频率和发生率百分比以及连续变量的均值和范围。
本研究共纳入181例患者，中位随访时间为58个月（平均43个月，范围12 - 96个月）。总体再次手术率为7.2%（13例患者）；11例患者（6%）因椎间盘突出复发（6例患者，3.3%）和再狭窄（5例患者，2.8%）出现复发性神经根症状，1例患者（0.55%）因伤口感染，1例患者（0.55%）因术后血肿。在11例因复发性神经根症状接受再次手术的患者中，有1例患者还伴有持续性脑脊液漏和浅表性后伤口感染。外侧软性椎间盘突出和脊椎病在再次手术率方面无显著差异。出院时，89%的患者获得了优良疗效；按照奥多姆标准，长期成功率为97.2%。
显微外科PCF是治疗外侧脊神经根受压的有效技术。为取得最佳效果，必须进行恰当的患者选择。
