Lee Dong-Ho, Hwang Chang Ju, Cho Jae Hwan, Park Sehan
Department of Orthopedic Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
Clin Spine Surg. 2025 Apr 1;38(3):E160-E167. doi: 10.1097/BSD.0000000000001679. Epub 2024 Oct 2.
A retrospective cohort study.
Guttering is a technique that creates a tunnel through the vertebral body adjacent to the endplate to remove compressive pathologies behind the vertebral body during anterior cervical discectomy and fusion (ACDF). In this study, we investigated cases of patients who underwent gutter-shaped osteotomy (guttering) to decompress retro-corporeal compressive lesions.
Retro-corporeal pathologies causing cord compression cannot be removed using conventional ACDF.
A total of 217 patients who underwent ACDF to treat cervical myelopathy and were followed up for ≥1 year were retrospectively reviewed. The fusion rate, subsidence, neck pain visual analog scale (VAS), arm pain VAS, and neck disability index (NDI) were assessed. Results were compared between the guttering (patients for whom guttering was performed) and nonguttering (patients for whom guttering was not performed) groups.
Thirty-five patients (16.1%) were included in the guttering group, while 182 patients (83.8%) were included in the nonguttering group. Fusion rates assessed by interspinous motion ( P =0.559) and bone bridging on computed tomography (CT) ( P =0.541 and 0.715, respectively) were not significantly different between the 2 groups at 1 year after surgery. Furthermore, neck pain VAS ( P =0.492), arm pain VAS ( P =0.099), and NDI ( P =1.000) 1 year after surgery did not demonstrate significant intergroup differences. All patients in the guttering group exhibited healed guttering on 1-year postsurgery CT.
Guttering as an adjunct to ACDF could provide a more expansive workspace for complete decompression when compressive pathology extends retrocorporeal. This additional bone resection is not associated with increased pseudarthrosis or subsidence or related to aggravation of patient symptoms.
Level III.
一项回顾性队列研究。
开槽术是一种在前路颈椎间盘切除融合术（ACDF）期间，在临近终板的椎体中创建一条通道，以去除椎体后方压迫性病变的技术。在本研究中，我们调查了接受开槽形截骨术（开槽术）以减压椎体后压迫性病变的患者病例。
使用传统的ACDF无法去除导致脊髓压迫的椎体后病变。
回顾性分析了总共217例行ACDF治疗颈椎病且随访时间≥1年的患者。评估融合率、沉降情况、颈部疼痛视觉模拟量表（VAS）、手臂疼痛VAS以及颈部功能障碍指数（NDI）。比较开槽组（接受开槽术的患者）和非开槽组（未接受开槽术的患者）的结果。
开槽组纳入35例患者（16.1%），非开槽组纳入182例患者（83.8%）。术后1年，通过棘突间活动评估的融合率（P = 0.559）以及通过计算机断层扫描（CT）评估的骨桥形成情况（分别为P = 0.541和0.715）在两组之间无显著差异。此外，术后1年的颈部疼痛VAS（P = 0.492）、手臂疼痛VAS（P = 0.099）和NDI（P = 1.000）在组间无显著差异。开槽组所有患者术后1年的CT显示开槽愈合。
当压迫性病变延伸至椎体后方时，开槽术作为ACDF的辅助手段可为完全减压提供更广阔的工作空间。这种额外的骨切除与假关节形成增加或沉降无关，也与患者症状加重无关。
三级。
