Department of Orthopaedic Surgery, Yonsei University College of Medicine, Seoul, Korea.
Clin Spine Surg. 2021 May 1;34(4):E237-E242. doi: 10.1097/BSD.0000000000001117.
This was a prospective cohort study.
To find out any differences in clinical outcomes when adding an en bloc total uncinate process resection (TUPR) to conventional anterior cervical discectomy and fusion (ACDF) to relieve an impinged nerve root.
There has been a long debate on the extent of cervical decompression needed when ACDF is done for patients with foraminal stenosis.
We included 606 patients who underwent ACDF due to foraminal stenosis. Minimum follow-up was 2 years. Patients with a soft disk herniation, myelopathy, anterior-posterior combined surgery or revision surgery were excluded. There were 275 patients (group U) who underwent ACDF with TUPR and 331 patients (group N) who underwent ACDF without TUPR. Clinical outcome measures were neck pain and arm pain, both assessed using Visual Analog Scale (VAS). We also measured Neck Disability Index (NDI) and patient-reported subjective improvement rate (PRSIR) in percentage. These parameters were measured preoperatively, immediately postoperatively, at 6 weeks as well as 3, 6, 9, 12 and 24 months. Statistical analysis was performed using independent sample t test and paired sample t test.
Preoperative neck and arm pain, and NDI were similar between the 2 groups. All 4 parameters in both groups improved significantly at 6 weeks follow-up and the improved outcomes were maintained up to the 24 month follow-up. There were no significant differences between the 2 groups in overall neck pain VAS, NDI, and PRSIR. There was a significant difference in arm pain VAS statistically all throughout the follow-up period, with group U having lesser arm pain.
Overall clinical outcomes were significantly improved after the ACDF whether an en bloc uncinate process resection was added or not. However, arm pain VAS was significantly less statistically in the uncinate resection group at all times.
这是一项前瞻性队列研究。
当在常规前路颈椎间盘切除融合术（ACDF）中增加整块钩突切除术（TUPR）以缓解受压神经根时，发现临床结果的任何差异。
对于存在椎间孔狭窄的患者行 ACDF 时需要进行多大程度的颈椎减压，一直存在着长期的争论。
我们纳入了 606 例因椎间孔狭窄而行 ACDF 的患者。随访时间至少为 2 年。排除椎间盘突出症、脊髓病、前后联合手术或翻修手术的患者。其中 275 例（U 组）患者行 ACDF 联合 TUPR，331 例（N 组）患者行 ACDF 不联合 TUPR。临床结果评估指标为颈痛和臂痛，均采用视觉模拟量表（VAS）进行评估。我们还测量了颈椎残障指数（NDI）和患者报告的主观改善率（PRSIR），以百分比表示。这些参数在术前、术后即刻、6 周以及 3、6、9、12 和 24 个月进行测量。采用独立样本 t 检验和配对样本 t 检验进行统计学分析。
两组患者术前颈痛和臂痛以及 NDI 相似。两组患者在 6 周随访时所有 4 项参数均显著改善，且改善结果持续至 24 个月随访。两组患者的总体颈痛 VAS、NDI 和 PRSIR 无显著差异。臂痛 VAS 在整个随访期间存在统计学差异，U 组的臂痛明显较轻。
无论是否进行整块钩突切除术，ACDF 后总体临床结果均显著改善。然而，在所有时间点，钩突切除组的臂痛 VAS 均具有统计学意义上的显著减轻。
