Department of Spine Surgery, Cantonal Hospital, Baden, Switzerland.
Department of Radiology, Cantonal Hospital, Baden, Switzerland.
Clin Neurol Neurosurg. 2021 Jan;200:106332. doi: 10.1016/j.clineuro.2020.106332. Epub 2020 Oct 25.
Anterior cervical decompression surgery exposes the vertebral artery to the risk of injury. This risk can increase if the natural course of the vertebral artery is altered. Therefore, this study evaluated if the distance between surgical landmarks and the vertebral artery decrease with the progression of cervical disc degeneration.
This study analyzed 40 patients with cervical magnetic resonance imaging. We evaluated the distance between the uncinate process and the vertebral artery in axial-plane T2 weighted sequences of the cervical levels C3-C6. The cervical disc degeneration was graded according to the Pfirrmann- and Suzuki classification. The decrease of the distance was evaluated using a one-way ANOVA.
The distance between the uncinate process and the vertebral artery decreased with increasing disc degeneration (p ≤ 0.015). ROC analysis provided an acceptable area under the curve in both classifications for the detection of a vertebral artery to the uncinate process distance of zero. The presence of Pfirrmann grade V had a positive predictive value of 69% for the presence of contact between the uncinate process and the vertebral artery.
High-grade cervical disc degeneration according to the Pfirrmann- and the Suzuki classification decrease the distance between the uncinate process and the vertebral artery. High-grade disc degeneration therefore should raise the awareness of the surgeon for the loss of the distance between surgical landmarks and the vertebral artery. However, screening for high-grade disc degeneration alone cannot substitute the thorough evaluation of the anatomical course of the vertebral artery before surgery.
颈椎前路减压术使椎动脉容易受到损伤。如果椎动脉的自然走行发生改变，这种风险会增加。因此，本研究评估了颈椎间盘退变的进展是否会导致手术标志点与椎动脉之间的距离缩短。
本研究分析了 40 例颈椎磁共振成像患者。我们评估了颈椎 3-6 水平轴位 T2 加权序列中钩突与椎动脉之间的距离。颈椎间盘退变根据 Pfirrmann 和 Suzuki 分级进行评估。使用单向方差分析评估距离的减小。
随着椎间盘退变程度的增加，钩突与椎动脉之间的距离减小（p≤0.015）。ROC 分析在两种分类中都提供了可接受的曲线下面积，用于检测椎动脉到钩突的距离为零。Pfirrmann 分级为 V 级对钩突与椎动脉之间存在接触的阳性预测值为 69%。
根据 Pfirrmann 和 Suzuki 分级，颈椎间盘高度退变会减小钩突与椎动脉之间的距离。因此，高度退变的椎间盘应引起外科医生对手术标志点与椎动脉之间距离丢失的重视。然而，仅对高度退变的椎间盘进行筛查并不能替代在手术前对椎动脉解剖走行的全面评估。
