Maduri Rodolfo, Cossu Giulia, Aureli Viviana, Wüthrich Sonia Plaza, Bobinski Lukas, Duff John Michael
Avaton Surgical Group, Clinique de Genolier, Swiss Medical Network, Genolier, Switzerland.
Department of Clinical Neurosciences, Service of Neurosurgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Asian Spine J. 2021 Oct;15(5):673-681. doi: 10.31616/asj.2020.0323. Epub 2020 Nov 16.
This was a retrospective review of patients with compressive cervical radiculopathy treated with a minimally invasive anterior cervical foraminotomy (ACF).
This study aimed to evaluate the results and complication rates of ACF in a consecutive series of patients and to report our clinical results of ACF as a minimally invasive technique in a series of 45 consecutive patients treated for compressive cervical radiculopathy.
ACF is a motion-sparing procedure and an alternative to anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy for direct nerve root decompression in patients with compressive cervical radiculopathy.
The chart review recorded clinical and radiological features preoperatively and postoperatively and at follow-up (FU). The effect of prognostic factors was analyzed in relation to the clinical outcome.
Between January 2004 and October 2019, 45 patients (15 females and 30 males) with a mean age of 55.9 years (range, 28-78 years) underwent ACF for unilateral cervical radiculopathy. The global clinical outcome according to the MacNab scale was evaluated as excellent in 64.5% of patients (n=29), good in 28.9% (n=13), fair in 4.4% (n=2), and poor in 2.2% (n=1). The radiological FU was available for 73.3% (n=33). The statistical analysis revealed no influence of age, sex, operated level, and side on the clinical outcome. Only one patient (2.2%) exhibited spontaneous bone fusion at the operated level on FU after a right-sided C6-7 ACF with no clinical consequences. No patient presented with signs of delayed segmental instability. The overall reoperation rate of this series was 4.4%.
ACF is a feasible and low-cost alternative to ACDF in selected patients with cervical radiculopathy. The use of tubular retractors in ACF may confer an added advantage that creates a safe corridor for direct cervical root decompression yet minimizing surrounding soft tissue retraction and avoiding unnecessary bone removal.
这是一项对采用微创前路颈椎椎间孔切开术（ACF）治疗的压迫性颈神经根病患者的回顾性研究。
本研究旨在评估连续一系列患者中ACF的结果和并发症发生率，并报告我们作为一种微创技术，在连续45例接受压迫性颈神经根病治疗的患者中应用ACF的临床结果。
ACF是一种保留运动功能的手术，是前路颈椎间盘切除融合术（ACDF）和后路颈椎椎间孔切开术的替代方法，用于对压迫性颈神经根病患者进行直接神经根减压。
病历回顾记录了术前、术后及随访（FU）时的临床和放射学特征。分析了预后因素与临床结果的关系。
2004年1月至2019年10月，45例（15例女性和30例男性）平均年龄55.9岁（范围28 - 78岁）的患者因单侧颈神经根病接受了ACF手术。根据MacNab量表评估，64.5%（n = 29）的患者总体临床结果为优，28.9%（n = 13）为良，4.4%（n = 2）为中，2.2%（n = 1）为差。73.3%（n = 33）的患者有放射学随访资料。统计分析显示年龄、性别、手术节段和手术侧别对临床结果无影响。仅1例患者（2.2%）在右侧C6 - 7 ACF术后随访时在手术节段出现自发骨融合，无临床后果。无患者出现节段性延迟不稳定的体征。本系列的总体再次手术率为4.4%。
对于选定的颈神经根病患者，ACF是一种可行且低成本的ACDF替代方法。在ACF中使用管状牵开器可能具有额外优势，可为直接颈椎神经根减压创造安全通道，同时最大限度减少周围软组织牵拉并避免不必要的骨质切除。
