Department of Neurosurgery, Seoul St. Mary's Hospital, The Catholic University of Korea, Seoul, South Korea; Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, PR China.
Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, PR China.
World Neurosurg. 2019 Sep;129:e485-e493. doi: 10.1016/j.wneu.2019.05.188. Epub 2019 May 29.
OBJECTIVE: To evaluate clinical and radiologic results as well as biomechanical changes after anterior cervical discectomy and fusion (ACDF), cervical disc replacement (CDR), and posterior cervical foraminotomy (PCF) and/or discectomy in individuals with unilateral single-level cervical radiculopathy. METHODS: A total of 97 patients received surgical treatment for unilateral intolerable radiculopathy between February 2012 and August 2017. Clinical outcomes included Neck Disability Index (NDI), visual analogue scale (VAS) for neck and arm pain, and modified Odom's criteria. Range of motion (ROM) of the whole cervical (C-ROM), operated segment (S-ROM), and upper and lower adjacent segment (U-ROM and L-ROM) were measured. RESULTS: A total of 55 ACDFs, 21 CDRs, and 21 PCFs were performed. Clinical improvement in NDI and VAS scores were significant after surgery; however, there was no statistical significance among groups. Satisfaction rate (based on Odom's criteria) of PCF (76.2%) was inferior to that of ACDF (90.9%) and CDR (90.5%) without statistical difference. S-ROM, U-ROM, and L-ROM were slightly better in the CDR and PCF groups, without statistical significance. C-ROM significantly increased in CDR group (P = 0.04) and slightly increased in PCF group (P = 0.27). In the ACDF group, C-ROM decreased (P = 0.21) and on the contrary, the U-ROM and L-ROM increased (P > 0.05). CONCLUSIONS: ACDF, CDR, and PCF resulted in pain relief and improvement in neck function for patients with unilateral radiculopathy. Comparatively, ACDF provides the lowest reoperation rate. CDR is effective in ameliorating cervical ROMs. PCF has a greater probability of reoperation; however, ROM after surgery is better than with ACDF.
目的:评估颈椎单侧单节段神经根病患者行前路颈椎间盘切除融合术(ACDF)、颈椎间盘置换术(CDR)、后路颈椎侧块减压术(PCF)和/或椎间盘切除术的临床和影像学结果以及生物力学变化。
方法:2012 年 2 月至 2017 年 8 月,共有 97 例单侧神经根病患者接受手术治疗。临床结果包括颈部残疾指数(NDI)、颈部和手臂疼痛视觉模拟量表(VAS)评分以及改良 Odom 标准。测量全颈椎(C-ROM)、手术节段(S-ROM)和上下相邻节段(U-ROM 和 L-ROM)的活动度(ROM)。
结果:共行 55 例 ACDF、21 例 CDR 和 21 例 PCF。手术后 NDI 和 VAS 评分均有显著改善,但组间无统计学差异。PCF 的满意率(基于 Odom 标准)(76.2%)低于 ACDF(90.9%)和 CDR(90.5%),但无统计学差异。CDR 和 PCF 组的 S-ROM、U-ROM 和 L-ROM 略好,但无统计学意义。CDR 组 C-ROM 明显增加(P=0.04),PCF 组略有增加(P=0.27)。ACDF 组 C-ROM 减少(P=0.21),而 U-ROM 和 L-ROM 增加(P>0.05)。
结论:ACDF、CDR 和 PCF 均能缓解单侧神经根病患者的疼痛并改善颈部功能。相对而言,ACDF 提供的再手术率最低。CDR 可有效改善颈椎 ROM。PCF 有较高的再手术概率,但术后 ROM 优于 ACDF。
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