Long-Term Clinical and Radiologic Outcomes of Minimally Invasive Posterior Cervical Foraminotomy

Objective

To report long-term clinical and radiological outcomes of minimally invasive posterior cervical foraminotomy (MI-PCF) performed in patients with unilateral single-level cervical radiculopathy.

Methods

Of forty-six patients who underwent MI-PCF for unilateral single-level radiculopathy between 2005 and 2013, 33 patients were included in the study, with a mean follow-up of 32.7 months. Patients were regularly followed for clinical and radiological assessment. Clinical outcome was measured by visual analogue scale (VAS) for the neck/shoulder and arm, and the neck disability index (NDI). Radiological outcome was measured by focal/global angulation and disc height index (DHI). Outcomes after MI-PCF were evaluated as changes of clinical and radiological parameters from the baseline. Mixed effect model with random patients'' effect was used to test for differences in the clinical and radiological parameters repeat measures.

Results

There were no complications and all patients had an uneventful recovery during the early postoperative period. VAS scores for neck/shoulder and arm improved significantly in the early postoperative period (3 months) and were maintained with time (p<0.001). NDI improved significantly post-operatively and tended to decrease gradually during the follow-up period (p<0.001). There were no statistically significant changes in focal and global angulation at follow-up. Percent DHIs of the upper adjacent or operated disc were maintained without significant changes with time. During the follow-up, same site recurrence was not noted and adjacent segment disease requiring additional surgery occurred in two patients (6%) on the contra-lateral side.

Conclusion

MI-PCF provides long-term pain relief and functional restoration, accompanied by good long-term radiological outcome.     

颈椎管狭窄症双开门椎管成形并神经根管扩大术的临床意义研究

目的：探索一种颈椎管成形同时扩大神经根管的术式。方法：78例颈椎管狭窄症患，按施术方式不同分成两组，双开门成形并神经根管扩大术42例为A组，施术方法为：用微气钻在关节突内1／3处向前外斜挖骨槽，折断椎弓双开门成形后，神经根管后壁后移，从而扩大神经根管，单纯椎板双开门成形术36例为B组，对比观察两组疗效。结果：78例获18个月－4年10个月，平均2年4个月的随访，优良率分别为：A组88．1％，B组63．9％，B组63．9％，统计学处理：0．05＞P＞0．01，差异有显性。结论：双开门椎管成形并神经根管扩大术式，减压有效，克服了单纯椎板成形术后脊髓，神经根后移，根管后壁对神经根造成的压迫或刺激。     

经皮椎间孔镜治疗腰椎管狭窄症临床疗效评价

目的:评价经皮椎间孔镜入路治疗腰椎管狭窄症的临床疗效,从而对临床手术适应证的选择提供一定的理论依据。方法:对2014年6月到2016年1月收治的87例腰椎管狭窄症患者的临床资料进行回顾性分析,其中男45例,女42例;年龄25～81岁,平均55.14岁;L_(3,4)8例,L_(4,5)61例,L_5S_118例,均采用经皮椎间孔镜经椎间孔入路进行减压手术。术前,术后3、6个月对患者的临床症状及神经功能采用VAS、ODI进行评估,并采用MacNab评分标准对疗效进行评定。结果:87例患者术后伤口均愈合良好,无并发症,均获得6个月以上的随访。术前及术后3、6个月,VAS评分(评分表按mm计算,总分为100分)分别为63.88±8.56、13.22±8.24、6.83±9.43;ODI评分为59.96±12.60、9.08±10.55、5.64±6.84,术后3、6个月与术前比较,差异有统计学意义(P0.01)。按照MacNab标准评定疗效,结果优41例,良30例,可7例,差9例。结论:经皮椎间孔镜入路治疗腰椎管狭窄症如果适应证选择恰当可以达到比较好的临床效果,对于黄韧带肥厚或者合并一些骨化狭窄的患者,则不能充分减压可能导致治疗效果不理想。     

通道显微镜下颈后路椎间孔扩大成形术治疗单节段神经根型颈椎病的临床疗效

目的 探讨通道显微镜下颈后路椎间孔扩大成形(PCF)椎间盘摘除术治疗单节段神经根型颈椎病(CSR)的临床疗效。方法 回顾性分析2014年1月—2017年1月中国科学技术大学附属第一医院脊柱外科行PCF手术治疗的30例单节段神经根型颈椎病患者临床资料,分析患者围手术期指标、上肢疼痛视觉模拟评分(VAS)、颈椎功能障碍指数(NDI)、颈椎生理曲度、椎间隙高度及节段稳定性。结果 30例患者平均切口长度为(2.2±0.2)cm,手术时间为(50±4.8)min,术中出血量为(80.5±18.6)mL。所有患者获得随访,平均随访时间18.6(12~25)个月。上肢疼痛VAS术前、术后1天、术后1年分别为(7.83±2.10)、(1.80±0.41)、(1.20±0.81)分;上肢疼痛VAS术后1天及术后1年时较术前均明显改善,差异有统计学意义(P值均＜0.05)。NDI由术前的30.23±4.81降至术后1年时的2.40±0.62,差异有统计学意义(P＜0.05)。颈椎生理曲度术前12.28°±8.34°,末次随访时为14.32°±4.56°,差异无统计学意义(P＞0.05)。术前和末次随访时病变节段椎间隙高度分别为(5.62±1.28) mm、(5.34±1.13) mm,差异无统计学意义(P＞0.05)。末次随访时未见颈椎失稳患者。结论 通道显微镜下颈后路椎间孔扩大成形术治疗单节段神经根型颈椎病均可获得较为满意的临床疗效,具有创伤小、恢复快等优点。     

经对侧椎间孔入路切除技术治疗高度游离腰椎间盘脱出的临床效果及其对基质金属蛋白酶3表达水平影响研究

目的　探讨经对侧椎间孔入路切除技术治疗高度游离腰椎间盘脱出的临床效果及其对基质金属蛋白酶3（MMP-3）表达水平的影响。方法　选择2012年1月—2017年2月在河北省人民医院诊治的高度游离腰椎间盘脱出患者144例,根据随机数字表法将患者分为观察组（采用经对侧椎间孔入路切除技术治疗）与对照组（采用经患侧椎间孔入路切除技术治疗）,各72例。收集患者一般资料,记录患者的手术指标、疼痛视觉模拟评分（VAS）、MMP-3表达水平、临床疗效。结果　两组患者手术时间、术中X线检查次数比较,差异无统计学意义（P>0.05）;观察组患者并发症（马尾神经损伤、椎间隙感染、硬脊膜损伤）发生率低于对照组（P<0.05）。对照组与观察组患者术后3个月VAS均低于本组术前（P<0.05）;两组患者术前、术后3个月VAS比较,差异无统计学意义（P>0.05）。观察组与对照组患者术后3个月MMP-3表达水平均低于本组术前（P<0.05）;观察组患者术后3个月MMP-3表达水平低于对照组（P<0.05）。观察组的优良率高于对照组（P<0.05）。结论　经对侧椎间孔入路切除技术能有效缓解高度游离腰椎间盘脱出患者疼痛,并不增加手术时间与X线检查次数,能有效降低MMP-3表达水平,减少术后并发症的发生,从而提高总体预后疗效。 椎间盘移位;椎间孔切开术;基质金属蛋白酶3     

Anatomical Morphometric Study of the Cervical Uncinate Process and Surrounding Structures

Objective

The purpose of this study is to elucidate the anatomic relationships between the uncinate process and surrounding neurovascular structures to prevent possible complications in anterior cervical surgery.

Methods

Twenty-eight formalin-fixed cervical spines were removed from adult cadavers and were studied. The authors investigated the morphometric relationships between the uncinate process, vertebral artery and adjacent nerve roots.

Results

The height of the uncinate process was 5.6-7.5 mm and the width was 5.8-8.0 mm. The angle between the posterior tip of the uncinate process and vertebral artery was 32.2-42.4°. The distance from the upper tip of the uncinate process to the vertebral body immediately above was 2.1-3.3 mm, and this distance was narrowest at the fifth cervical vertebrae. The distance from the posterior tip of the uncinate process to the nerve root was 1.3-2.0 mm. The distance from the uncinate process to the vertebral artery was measured at three different points of the uncinate process : upper-posterior tip, lateral wall and the most antero-medial point of the uncinate process, and the distances were 3.6-6.1 mm, 1.7-2.8 mm, and 4.2-5.7 mm, respectively. The distance from the uncinate process tip to the vertebral artery and the angle between the uncinate process tip and vertebral artery were significantly different between the right and left side.

Conclusion

These data provide guidelines for anterior cervical surgery, and will aid in reducing neurovascular injury during anterior cervical surgery, especially in anterior microforaminotomy.     

Fully endoscopic lumbar spinal surgery: Is it time to change?

Spinal surgery is becoming safer and progressively less invasive with advances in optical and instrument technology. The amount of decompression achievable with endoscopic approaches is now comparable to open approaches with the advantage of much less tissue trauma. This review aims at examining the status of endoscopic approaches in lumbar decompressive surgery.     

显微内镜下颈椎后路椎间孔切开减压术的疗效探讨

目的探讨显微内镜下颈椎后路椎间孔切开减压术治疗神经根型颈椎病及颈椎间盘突出症的临床疗效。方法2004年2月-2007年6月,于显微内镜下行颈椎后路椎间孔切开减压术24例。男16例,女8例;年龄42～68岁,平均59岁。其中神经根型颈椎病16例,颈椎间盘突出症8例。病变节段:C4、58例,C5、612例,C6、74例。病程6～15个月。影像学检查显示8例颈椎间盘突出症中软性突出物6例、硬性突出物2例;神经根型颈椎病的受压因素主要为黄韧带肥厚、钩椎关节增生及关节突关节位置异常。根据日本骨科协会(JOA)脊髓功能评分法评定为(12.60±1.52)分。结果手术时间90～120min,平均100min;术中出血量100～150mL,平均120mL。1例全麻手术患者术中为切除钙化的突出髓核组织造成神经根牵拉伤,术后采用甲泼尼龙冲击治疗后3个月神经根功能恢复;其余患者术后神经根疼痛症状明显改善19例,减轻4例。术后影像学检查显示手术部位减压彻底。24例均获随访,随访时间24～36个月,平均28个月。X线片及CT检查示椎间高度无明显丢失,生理曲度正常。术后24个月根据JOA脊髓功能评分法评定为(16.10±0.29)分,与术前比较差异有统计学意义(P0.01)。结论显微内镜下颈椎后路椎间孔切开减压术可通过小切口快捷进入术区,减少了组织损伤,避免了椎间高度丢失,临床疗效优良。     

Modified transcorporeal anterior cervical microforaminotomy for cervical radiculopathy: a technical note and early results

A prospective analysis of the first twenty patients operated for cervical radiculopathy by a new modification of transcorporeal anterior cervical foraminotomy technique. To evaluate early results of a functional disc surgery in which decompression for the cervical radiculopathy is done by drilling a hole in the upper vertebral body and most of the disc tissue is preserved. Earlier approaches to cervical disc surgery either advocated simple discectomy or discectomy with fusion, ultimately leading to loss of motion segment. Posterior foraminotomy does not address the more common anterior lesion. Twenty patients suffering from cervical radiculopathy not responding to conservative treatment were chosen for the new technique. Upper vertebral transcorporeal foraminotomy was performed with the modified technique in all the patients. All the patients experienced immediate/early relief of symptoms. No complications of vertebral artery injury, Horner’s syndrome or recurrent laryngeal nerve palsy were noted. Modified transcorporeal anterior cervical microforaminotomy is an effective treatment for cervical radiculopathy. It avoids unnecessary violation of the disc space and much of the bony stabilizers of the cervical spine. Short-term results of this technique are quite encouraging. Longer-term analysis can help in outlining the true benefits of this technique.