Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea.
PLoS One. 2023 Feb 21;18(2):e0281926. doi: 10.1371/journal.pone.0281926. eCollection 2023.
Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of posterior cervical structures, such as facet joint, cervical kinematics was minimally changed. However, a larger resection of facet joint is required for cervical foraminal stenosis (FS) than disc herniation (DH). The objective was to compare the cervical kinematics between patients with FS and DH after PECF.
Consecutive 52 patients (DH, 34 vs. FS, 18) who underwent PECF for single-level radiculopathy were retrospectively reviewed. Clinical parameters (neck disability index, neck pain and arm pain), and segmental, cervical and global radiological parameters were compared at postoperative 3, 6, and 12 months, and yearly thereafter. A linear mixed-effect model was used to assess interactions between groups and time. Any occurrence of significant pain during follow-up was recorded during a mean follow-up period of 45.5 months (range 24-113 months).
Clinical parameters improved after PECF, with no significant differences between groups. Recurrent pain occurred in 6 patients and surgery (PECF, anterior discectomy and fusion) was performed in 2 patients. Pain-free survival rate was 91% for DH and 83% for FS, with no significant difference between the groups (P = 0.29). Radiological changes were not different between groups (P > 0.05). Segmental neutral and extension curvature became more lordotic. Cervical curvature became more lordotic on neutral and extension X-rays, and the range of cervical motion increased. The mismatch between T1-slope and cervical curvature decreased. Disc height did not change, but the index level showed degeneration at postoperative 2 years.
Clinical and radiological outcomes after PECF were not different between DH and FS patients and kinematics were significantly improved. These findings may be informative in a shared decision-making process.
后路全内镜下颈椎侧方椎间孔切开术（PECF）是治疗颈椎神经根病的微创外科技术之一。由于对后颈椎结构（如关节突关节）的破坏最小，颈椎运动学变化最小。然而，颈椎管狭窄症（FS）比椎间盘突出症（DH）需要更大的关节突切除。目的是比较 PECF 治疗单节段神经根病后 FS 和 DH 患者的颈椎运动学。
回顾性分析了连续 52 例（DH 组 34 例，FS 组 18 例）接受 PECF 治疗的单节段神经根病患者。术后 3、6、12 个月及以后每年比较临床参数（颈椎障碍指数、颈痛和臂痛）和节段、颈椎和整体影像学参数。采用线性混合效应模型评估组间和时间的相互作用。在平均随访 45.5 个月（24-113 个月）期间，记录任何随访期间出现的显著疼痛。
PECF 后临床参数改善，组间无显著差异。6 例患者出现复发性疼痛，2 例患者行手术（PECF、前路椎间盘切除融合术）。DH 和 FS 的无疼痛生存率分别为 91%和 83%，组间无显著差异（P=0.29）。组间影像学变化无差异（P>0.05）。节段中立和伸展曲率变得更前凸。中立位和伸展位 X 线颈椎曲率更前凸，颈椎活动范围增加。T1 斜率与颈椎曲率之间的不匹配减少。椎间盘高度无变化，但在术后 2 年索引水平显示退变。
DH 和 FS 患者 PECF 后的临床和影像学结果无差异，运动学显著改善。这些发现可能对共同决策过程提供信息。
