Sarmiento J Manuel, Hanna George, Baron Eli M, Lanman Todd H, Lauryssen Carl, Cuéllar Jason M
Cedars-Sinai Spine Center, Los Angeles, CA, USA
Cedars-Sinai Spine Center, Los Angeles, CA, USA.
Int J Spine Surg. 2022 Apr;16(2):384-392. doi: 10.14444/8219.
Patients may occasionally have persistent or recurrent radicular symptoms after cervical artificial disc replacement (ADR) for cervical spondylotic radiculopathy. We describe our approach using anterior cervical foraminotomy (ACF) to provide symptom relief in such patients without the need to convert to a fusion or remove the ADR implant.
Our operative technique for ACF after cervical ADR begins by starting at the lateral edge of the ADR at the superior end plate of the inferior vertebral body. The ipsilateral uncovertebral joint is drilled with a combination of a high-speed burr and diamond-coated burr to minimize the risk of injury to the vertebral artery. The neuroforamen is entered after drilling through the posterior aspect of the uncinate process. The exiting cervical nerve root should be directly visualized, and a Kerrison rongeur may be used to trace along the nerve root laterally to remove any remaining uncinate osteophyte or process. We queried our internal database for patients with recurrent or new radicular pain following cervical ADR who underwent ACF. Clinical characteristics and outcomes were reported.
Five patients with recurrent radicular symptoms after ADR were reviewed. Two ACFs were performed at C5-6, and 2 were performed at C6-7. Four patients developed ipsilateral recurrent radicular symptoms, and only 1 patient developed contralateral new radicular symptoms. Three patients reported complete resolution of their new or recurrent radicular symptoms following ACF, and 2 patients reported only partial resolution. No patients required conversion to a fusion.
In patients with recurrent symptoms of cervical spondylotic radiculopathy following ADR, ACF with uncovertebral joint resection can be used to provide direct foraminal decompression without the need for implant removal. This approach also preserves motion at the affected level, preserves cervical spinal stability, and prevents the need for spinal fusion.
Patients with persistent or recurrent radicular symptoms after cervical ADR may achieve resolution of symptoms through a modified ACF technique.
对于神经根型颈椎病患者，在进行颈椎人工椎间盘置换（ADR）后，患者偶尔会出现持续或反复的神经根症状。我们描述了使用颈椎前路椎间孔切开术（ACF）来缓解此类患者症状的方法，而无需转为融合手术或移除ADR植入物。
我们在颈椎ADR后进行ACF的手术技术，是从下位椎体上终板处ADR的外侧边缘开始。使用高速磨钻和金刚石涂层磨钻联合钻磨同侧钩椎关节，以将椎动脉损伤风险降至最低。在钻透钩椎关节的后方后进入神经孔。应直接观察到穿出的颈神经根，可使用Kerrison咬骨钳沿神经根向外侧追踪，以去除任何残留的钩椎骨赘或骨质。我们查询了内部数据库中接受ACF治疗的颈椎ADR后出现复发性或新发神经根性疼痛的患者。报告了临床特征和结果。
对5例ADR后出现复发性神经根症状的患者进行了回顾。2例ACF在C5 - 6节段进行，2例在C6 - 7节段进行。4例患者出现同侧复发性神经根症状，仅1例患者出现对侧新发神经根症状。3例患者报告ACF后新发或复发性神经根症状完全缓解，2例患者报告仅部分缓解。没有患者需要转为融合手术。
对于ADR后出现复发性神经根型颈椎病症状的患者，行钩椎关节切除的ACF可用于直接进行椎间孔减压，而无需移除植入物。该方法还能保留受累节段的活动度，维持颈椎稳定性，避免脊柱融合的需要。
颈椎ADR后出现持续或反复神经根症状的患者可通过改良的ACF技术实现症状缓解。
