附加钩突切除术是否会增加前路颈椎间盘切除融合术后的假关节形成？
Does Additional Uncinate Resection Increase Pseudarthrosis Following Anterior Cervical Discectomy and Fusion?
机构信息
Department of Orthopedic Surgery, Asan Medical Center College of Medicine, University of Ulsan, Republic of Korea.
Department of Orthopedic Surgery, Gil Medical Center College of Medicine, University of Gachon, Incheon, Republic of Korea.
出版信息
Spine (Phila Pa 1976). 2018 Jan 15;43(2):97-104. doi: 10.1097/BRS.0000000000002271.
STUDY DESIGN
Retrospective comparative study.
OBJECTIVE
To investigate whether unilateral or bilateral uncinate resection (UR) combined with anterior cervical discectomy and fusion (ACDF) increases the risk of pseudarthrosis at long-term follow-up.
SUMMARY OF BACKGROUND DATA
Uncoforaminotomy (or UR), performed along with ACDF, facilitates better and faster improvement of arm pain. As uncovertebral joints are important for maintaining stability, they may affect the fusion process by causing segmental instability if resected during ACDF.
METHODS
We retrospectively examined 167 patients (89 men, 78 women; mean age, 58.4 ± 10.5 yr) who consecutively underwent single- or double-level ACDF and were followed for >2 years. UR was not performed in 46 patients (N-UR group). UR of at least one foramen was performed in 121 patients (UR group), including unilateral UR in 89 patients (U-UR group) and bilateral UR in 32 patients (B-UR group). Demographic data, fusion rate, visual analog scale (VAS) scores for neck/arm pain, and neck disability index (NDI) scores were compared between the N-UR and UR groups. Moreover, the fusion rates after the single- and double-level procedures were compared among the groups.
RESULTS
There was no difference in sex, age, weight, height, body mass index (BMI), and smoking history between the N-UR and UR groups. The fusion rates after single-level ACDF were not significantly different among the N-UR, U-UR, and B-UR groups (91.4%, 97.8%, and 88.2%; P = 0.290). Solid fusion was achieved in all groups after double-level ACDF (72.7%, 95.5%, and 86.7%), although the rates did not significantly differ among the groups (P = 0.071). The improvement in the VAS score for arm pain was significantly better in the UR group than in the N-UR group at short-term follow-up (P < 0.001).
CONCLUSION
Unilateral or bilateral UR does not affect the fusion rate after single- or double-level ACDF. Hence, if necessary, additional UR can be performed during ACDF without concern regarding nonunion.
LEVEL OF EVIDENCE
研究设计
回顾性对比研究。
目的
探讨单侧或双侧钩突切除术（UR）联合前路颈椎间盘切除融合术（ACDF）是否会增加长期随访时假关节形成的风险。
背景资料概要
钩突切开术（或 UR）与 ACDF 联合应用可促进手臂疼痛更快更好地改善。由于钩突关节对维持稳定性很重要，如果在 ACDF 中切除，它们可能会导致节段不稳定，从而影响融合过程。
方法
我们回顾性检查了 167 名（89 名男性，78 名女性；平均年龄 58.4±10.5 岁）连续接受单节段或双节段 ACDF 并随访>2 年的患者。46 名患者未行 UR（N-UR 组）。121 名患者行至少一个孔的 UR（UR 组），其中 89 名患者行单侧 UR（U-UR 组），32 名患者行双侧 UR（B-UR 组）。比较 N-UR 组和 UR 组之间的人口统计学数据、融合率、颈/臂痛视觉模拟评分（VAS）和颈部残疾指数（NDI）评分。此外，还比较了各组中单、双节段手术后的融合率。
结果
N-UR 组和 UR 组之间的性别、年龄、体重、身高、体重指数（BMI）和吸烟史无差异。单节段 ACDF 后融合率在 N-UR、U-UR 和 B-UR 组之间无显著差异（91.4%、97.8%和 88.2%；P=0.290）。所有组在双节段 ACDF 后均获得了稳定的融合（72.7%、95.5%和 86.7%），尽管组间无显著差异（P=0.071）。UR 组短期随访时手臂疼痛 VAS 评分的改善明显优于 N-UR 组（P<0.001）。
结论
单侧或双侧 UR 不影响单节段或双节段 ACDF 后的融合率。因此，如果需要，在 ACDF 期间可以进行额外的 UR，而不必担心不愈合。
证据水平
4。
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