Lee Dong-Ho, Lee Hyeong-Joo, Cho Jae Hwan, Hwang Chang Ju, Yang Jae Jun, Lee Choon Sung, Park Sehan
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Department of Orthopedic surgery, Busan Bumin Hospital, Republic of Korea.
Global Spine J. 2023 Oct;13(8):2357-2366. doi: 10.1177/21925682221083268. Epub 2022 Mar 24.
Retrospective cohort study.
To elucidate incidence, risk factor, and clinical effect of bone regrowth after posterior cervical foraminotomy (PCF).
Ninety-eight patients who underwent PCF for the treatment of cervical radiculopathy and were followed up for >2 years were retrospectively reviewed. Foraminal dimension, sagittal gap at resected area, facet thickness, lamina length, and cervical range of motion (ROM) were measured. Neck pain visual analogue scale (VAS), arm pain VAS, and neck disability index (NDI) were recorded. Radiographic measures were compared between segments with foraminal narrowing of ≥20% at the 2-years follow-up (restenosis segments) and foraminal narrowing of <20% (patent segments).
Sixty-nine patients with 109 segments were included. 73.4% (80/109) of foramens demonstrated foraminal narrowing and decrease of foraminal dimension of ≥20% occurred in 30.3% (30/109). Foraminal dimension at postoperative 2-days was significantly higher in the restenosis segments ( = .047). Furthermore, increase of foraminal dimension was significantly associated with foraminal restenosis of ≥20% ( = .018). Facet thickness was significantly higher in the restenosis segments compared to patent segments at postoperative 2-years follow-up ( = .038). Neck pain VAS was significantly aggravated only in the restenosis group at postoperative 2-years follow-up ( < .001).
Foraminal narrowing commonly occurs after PCF due to bone healing. Bone growth occurs in all directions while medial facet growth contributes more to foraminal restenosis. Greater widening of foramen during PCF is a risk factor for postoperative foramen restenosis. Therefore, amount of bone resection should be kept optimal and excessive resection should be avoided to prevent foramen restenosis.
回顾性队列研究。
阐明颈椎后路椎间孔切开术（PCF）后骨再生的发生率、危险因素及临床效果。
对98例行PCF治疗神经根型颈椎病且随访时间超过2年的患者进行回顾性分析。测量椎间孔尺寸、切除区域矢状间隙、关节突厚度、椎板长度及颈椎活动度（ROM）。记录颈部疼痛视觉模拟评分（VAS）、上肢疼痛VAS及颈部功能障碍指数（NDI）。比较2年随访时椎间孔狭窄≥20%的节段（再狭窄节段）和椎间孔狭窄<20%的节段（通畅节段）的影像学测量结果。
纳入69例患者共109个节段。73.4%（80/109）的椎间孔存在狭窄，30.3%（30/109）的椎间孔尺寸减小≥20%。再狭窄节段术后2天的椎间孔尺寸显著更高（P = .047）。此外，椎间孔尺寸增加与≥20%的椎间孔再狭窄显著相关（P = .018）。术后2年随访时，再狭窄节段的关节突厚度显著高于通畅节段（P = .038）。术后2年随访时，仅再狭窄组的颈部疼痛VAS显著加重（P < .001）。
PCF后因骨愈合常发生椎间孔狭窄。骨生长向各个方向发生，而内侧关节突生长对椎间孔再狭窄的影响更大。PCF期间椎间孔扩大程度更大是术后椎间孔再狭窄的危险因素。因此，应保持骨切除量最佳，避免过度切除以预防椎间孔再狭窄。
