Cui Shangbin, Nasser Al-Attar E, Ma Ling, Su Peiqiang, Su Deying, Liao Zhiheng
Spine Surgery Department, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou City, Guangdong Province, China.
J Orthop Translat. 2020 Apr 18;24:32-38. doi: 10.1016/j.jot.2020.03.011. eCollection 2020 Sep.
Although there are many researches that focus on the relationship between the vertebral artery and uncinate process (UP), there were no publications concerning difference in the dimensions of the UP between the normal spine and degenerative spine, especially in Chinese patient. The purpose of this study is to determine the anatomic parameters that can be used as a guide for the procedure in intervertebral foramen decompression and for analysis of the morphometric change in the UP of the cervical spondylosis patients.
Forty patients from January 2016 to January 2019 were enrolled in this study. Three-dimensional computed tomography scans of the cervical spine were performed. The patients were subdivided into two groups which were nondegenerative cervical spine group (20 cases) and degenerative cervical spine group (20 cases). Six parameters concerning the height, width and angle of the UP were measured.
In nondegenerative group, the average pedicle width was 3.63 mm-5.91 mm from C3 to C7. The average width of safe UP resection will be 3.06 mm at C3, 3.12 mm at C4, 3.28 mm at C5, 2.74 mm at C6 and 2.01 mm at C7. The average safe depth will be 6.04 mm at C3, 6.52 mm at C4, 7.61 mm at C5, 6.07 mm at C6 and 5.09 mm at C7. There are statistic difference between degenerative group and nondegenerative group, especially in the parameter minimum height of UP, maximum height of UP, medial border's distance of UP and later border's distance of UP.
In this retrospective study, our results suggest that for the Chinese patients who suffered from cervical spondylosis could be performed intervertebral foraminotomy decompression by resecting part of the UP. The safe range within the spinal canal was up to 6.73 mm of width between inferior vertebral endplate and superior vertebral endplate in the intervertebral space and up to 5.09 mm of depth from medial border of the UP to the lateral side atC3 to C7 without interfering the spinal nerve root and vertebral artery.
Our study found the safe margin to perform intervertebral foramen decompression to the UP for the cervical spondylosis patients. This may help to improve safeness of the surgical procedure and provide data for future robotic surgery.
尽管有许多研究关注椎动脉与钩突（UP）之间的关系，但关于正常脊柱和退变脊柱中UP尺寸差异的出版物却很少，尤其是在中国患者中。本研究的目的是确定可用于椎间孔减压手术指导以及分析颈椎病患者UP形态学变化的解剖学参数。
纳入2016年1月至2019年1月的40例患者。对颈椎进行三维计算机断层扫描。将患者分为两组，即非退变颈椎组（20例）和退变颈椎组（20例）。测量了与UP的高度、宽度和角度有关的六个参数。
在非退变组中，C3至C7的平均椎弓根宽度为3.63毫米至5.91毫米。C3处安全切除UP的平均宽度为3.06毫米，C4处为3.12毫米，C5处为3.28毫米，C6处为2.74毫米，C7处为2.01毫米。C3处的平均安全深度为6.04毫米，C4处为6.52毫米，C5处为7.61毫米，C6处为6.07毫米，C7处为5.09毫米。退变组和非退变组之间存在统计学差异，尤其是在UP的最小高度、最大高度、UP内侧边界距离和外侧边界距离参数方面。
在这项回顾性研究中，我们的结果表明，对于患有颈椎病的中国患者，可以通过切除部分UP进行椎间孔切开减压术。椎管内的安全范围是椎间间隙中椎体下终板与椎体上终板之间的宽度可达6.73毫米，从UP内侧边界到C3至C7外侧的深度可达5.09毫米，而不会干扰脊神经根和椎动脉。
我们的研究发现了对颈椎病患者进行UP椎间孔减压的安全边界。这可能有助于提高手术的安全性，并为未来的机器人手术提供数据。
