颈椎前路椎间孔切开术与颈椎后路椎间孔切开术治疗单节段单侧神经根型颈椎病的比较。
Comparison of Anterior Cervical Foraminotomy and Posterior Cervical Foraminotomy for Treating Single Level Unilateral Cervical Radiculopathy.
机构信息
Department of Neurosurgery, Chungdam Wooridul Spine Hospital, Seoul, Republic of Korea.
出版信息
Spine (Phila Pa 1976). 2019 Oct 1;44(19):1339-1347. doi: 10.1097/BRS.0000000000003081.
STUDY DESIGN
Retrospective study.
OBJECTIVE
To compare clinical and radiological outcomes after two surgical procedures.
SUMMARY OF BACKGROUND DATA
Anterior cervical discectomy and fusion is the gold standard treatment for cervical radiculopathy. Cervical foraminotomy is an alternative decompressive treatment option to preserve segmental motion and avoid fusion-related complications. Anterior cervical foraminotomy (ACF) and posterior cervical foraminotmy (PCF) has been introduced to achieve foraminal decompression. The objective of this study was to compare long-term clinical and radiological outcomes after two surgical procedures for the treatment of single-level cervical radiculopathy.
METHODS
A retrospective review of patients undergoing ACF or PCF for the treatment of single-level unilateral cervical radiculopathy from 2010 to 2012 was performed. Demographic, perioperative, and clinical outcomes of 40 patients for each group were collected from the electronic medical records. Clinical outcomes were assessed by visual analog scores, while disc height (DH), cervical lordosis (CL), and C2-7 sagittal vertical axis (C2-7 SVA) data were obtained from pre- and postoperative radiography data.
RESULTS
Both groups showed similar clinical improvements after surgery. Radiographically, the ACF groups showed profound decrease in DH only at the first month after surgery, and there was no significant change in DH after 1 year. The PCF group showed no significant changes in DH at follow-up. With respect to CL, ACF showed a significant decrease. There was no statistically significant change in C2-7 SVA before or after surgery in both groups.
CONCLUSION
Both ACF and PCF showed significant clinical improvement of radiculopathy. In the ACF group, the DH decreased, and CL decreased during the early postoperative period. Radiological parameters were preserved in the PCF group after surgery. However, this group showed greater intraoperative bleeding and revision rates. Care should be taken to manage complications according to the specific surgical treatment.
LEVEL OF EVIDENCE
研究设计
回顾性研究。
目的
比较两种手术方法的临床和影像学结果。
背景资料概要
前路颈椎间盘切除术和融合术是神经根型颈椎病的金标准治疗方法。颈椎侧块切除术是一种保留节段运动并避免融合相关并发症的减压治疗选择。前路颈椎侧块切除术（ACF）和后路颈椎侧块切除术（PCF）已被引入以实现椎间孔减压。本研究的目的是比较两种手术方法治疗单节段神经根型颈椎病的长期临床和影像学结果。
方法
对 2010 年至 2012 年间接受 ACF 或 PCF 治疗单节段单侧神经根型颈椎病的患者进行回顾性分析。从电子病历中收集了每组 40 例患者的人口统计学、围手术期和临床结果。临床结果通过视觉模拟评分评估，而术前和术后影像学数据则用于获取椎间盘高度（DH）、颈椎曲度（CL）和 C2-7 矢状垂直轴（C2-7 SVA）数据。
结果
两组患者术后均表现出相似的临床改善。影像学上，ACF 组仅在术后第一个月 DH 明显下降，1 年后 DH 无明显变化。PCF 组在随访时 DH 无明显变化。在 CL 方面，ACF 显示出显著的降低。两组术后 C2-7 SVA 均无统计学显著变化。
结论
ACF 和 PCF 均能显著改善神经根型颈椎病的临床症状。在 ACF 组，DH 在术后早期下降，CL 在术后早期下降。PCF 组术后影像学参数得到保留。然而，该组术中出血量和翻修率较大。应根据具体的手术治疗方法注意管理并发症。
证据等级
3 级。
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