Kim Ji Yeon, Kim Dae Hwan, Lee Yeon Jin, Jeon Jun Bok, Choi Su Yong, Kim Hyeun Sung, Jang Il-Tae
Department of Neurosurgery, Nanoori Gangnam Hospital, Seoul, Korea.
Neurospine. 2021 Mar;18(1):139-146. doi: 10.14245/ns.2040440.220. Epub 2021 Mar 31.
Posterior endoscopic cervical foraminotomy (PECF) is a well-established, minimally invasive surgery for cervical radiculopathy, but have the more chances of neural structure damage due to the limited visibility and steeper learning curve. So, the anatomical understanding of the nerve associated with the bony structure will be an essential surgical guideline.
We measured the distance between the bilateral dura lateral edge and bilateral V-point on axial cuts of cervical magnetic resonance imaging and 3-dimensional spine computed tomography imaging, respectively, from 80 patients. We then calculate the distance and position between the dura lateral edge and the V-point as surgically critical width (SCW). Transverse interdural distance (TIDW), transverse inter-V-point distance, and anatomical facet joint width were measured.
The mean TIDW decreased as the levels down in the 40s-60s but increased at the C4-5, C5-6, and C6-7 levels in the 70s. Statistically significant difference was shown at the C6-7 level between the 40s and the 70s. The mean anatomical inter-V-point distance markedly decreased at C5-6 and continued till the C7-Tl level at all age groups. Moreover, a statistically significant difference was shown at the C3-4 and C4-5 level between the 40s and the 70s. The mean negative values of SCW increased from the 40s to 70s at the C5-6 and C6-7 levels (C5-6: -0.60 ± 1.10 mm to -1.63 ± 1.56 mm; C6-7: -0.90 ± 0.74 mm to -2.18 ± 1.25 mm). There were statistically significant differences between the 2 aged groups at the C3-4, C4-5, C5-6, and C6-7 levels.
A prediction of the correlated position between the lateral dura edge and the V-point is essential for the PECF not to injure the neural structure. In the case of a performing the PECF at the C5-6 and C6-7 level in the old-aged patient, it should be considered the laterally moved dura edge, and more extended bony remove is needed for less neural structure damage.
后路颈椎椎间孔切开术（PECF）是治疗神经根型颈椎病成熟的微创手术，但由于视野有限和学习曲线较陡，神经结构损伤的几率更高。因此，了解与骨结构相关的神经解剖结构是手术的重要指导原则。
我们分别在80例患者的颈椎磁共振成像轴位切片和三维脊柱计算机断层扫描成像上测量双侧硬脊膜外侧缘与双侧V点之间的距离。然后计算硬脊膜外侧缘与V点之间的距离和位置，作为手术关键宽度（SCW）。测量硬膜间横向距离（TIDW）、V点间横向距离和解剖学小关节宽度。
40多岁至60多岁时，平均TIDW随节段下降而减小，但在70多岁时，C4-5、C5-6和C6-7节段有所增加。40多岁和70多岁时，C6-7节段差异有统计学意义。所有年龄组中，平均V点间解剖学距离在C5-6节段显著减小，并持续至C7-T1节段。此外，40多岁和70多岁时，C3-4和C4-5节段差异有统计学意义。C5-6和C6-7节段SCW的平均负值从40多岁到70多岁增加（C5-6：-0.60±1.10mm至-1.63±1.56mm；C6-7：-0.90±0.74mm至-2.18±1.25mm）。两个年龄组在C3-4、C4-5、C5-6和C6-7节段差异有统计学意义。
预测硬脊膜外侧缘与V点的相关位置对于PECF避免损伤神经结构至关重要。对于老年患者在C5-6和C6-7节段进行PECF时，应考虑硬脊膜外侧缘的移位，需要更广泛地去除骨质以减少神经结构损伤。
