The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years' clinical and radiographic follow-up Clinical article

被引:106
作者
Jagannathan, Jay [1 ]
Sherman, Jonathan H. [1 ]
Szabo, Tom [1 ]
Shaffrey, Christopher I. [1 ]
Jane, John A., Sr. [1 ]
机构
[1] Univ Virginia Hlth Syst, Dept Neurol Surg, Charlottesville, VA 22902 USA
关键词
cervical spine; disc disease; foraminotomy; radiculopathy; POSTLAMINECTOMY KYPHOSIS; UNILATERAL RADICULOPATHY; SPONDYLOTIC MYELOPATHY; SURGICAL-TREATMENT; SPINAL DEFORMITY; RADICULAR PAIN; ANTERIOR; LAMINECTOMY; DISC; CHILDREN;
D O I
10.3171/2008.12.SPINE08576
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Object. This study details long-term clinical and radiographic outcomes following single-level posterior cervical foraminotomy for degenerative disc or osteophyte disease. Methods. The authors conducted a retrospective review of 162 cases involving patients treated by a single surgeon using a posterior cervical foraminotomy. Inclusion criteria were a minimum of 5 years' clinical and radiographic follow-up and unilateral single-level posterior cervical foraminotomy for degenerative disease between C-3 and C-7. Patients who had undergone previous operations, those who underwent bilateral procedures, and those who underwent foraminotomy as part of a larger laminectomy were excluded. The Neck Disability Index (NDI) was used for clinical follow-Lip, and radiographic follow-up was performed using static and dynamic lateral radiographs to compare focal and segmental alignment and changes in disc-space height. Results. The mean presenting NDI score was 18 (range 2-39). The most common presenting symptoms were radiculopathy (110 patients [68%]), neck pain (85 patients [52%]), and subjective weakness (91 patients [56%]). The mean preoperative focal angulation at the surgically treated level was 4.2 degrees (median 4.1 degrees, range 7.3-15.3 degrees), and the mean preoperative segmental curvature between C-2 and C-7 was 18.0 degrees (median 19.3 degrees, range -22.1 to 39.3 degrees). The mean postoperative NDI score was 8 (range 0-39). Improvement in NDI scores was seen in 150 patients (93%). Resolution of radiculopathy was experienced by 104 patients (95% of patients with radiculopathy). The mean radiographic follow-up was 77.3 months (range 60-177 months). No statistically significant changes in focal or segmental kyphosis or disc-space height were seen among the overall cohort with time (Cox proportional hazards analysis and Student t-test, p > 0.05). The mean postoperative focal angulation was 4.1 degrees (median 3.9 degrees, range -9.9 degrees to 15.1 degrees) and mean postoperative segmental angulation was 17.6 degrees (median 15.4 degrees, range -40.2 to 35.3 degrees). Postoperative instability on dynamic imaging was present in 8 patients (4.9%); 7 of these patients were clinically asymptomatic and were treated conservatively, and I required cervical fusion. Postoperative loss of lordosis (defined as segmental Cobb angle < 10 degrees) was seen in 30 patients (20%),9 of whom had clinical symptoms and 4 of whom required further surgical correction. Factors associated with worsening sagittal alignment (Cox proportional hazards analysis, p < 0,05) included age > 60 at initial surgery, the presence of preoperative cervical lordosis of < 10 degrees, and the need for posterior surgery after the initial foraminotomy Conclusions. The posterior cervical foraminotomy is highly effective in treating patients with cervical radiculopathy and results in long-lasting pain relief and improved quality-of-life outcomes in most patients. Long-term radiographic follow-up shows no significant trend toward kyphosis, although select patient Subsets (patients older than 60 years, patients who had previous posterior surgery, and patients with < 10 degrees of lordosis preoperatively) appear to be at higher risk and require closer follow-up. (DOI: 10.3171/2008.12.SPINE08576)
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页码:347 / 356
页数:10
相关论文
共 34 条
[1]  
Albert TJ, 1998, SPINE, V23, P2738, DOI 10.1097/00007632-199812150-00014
[2]  
Anderson D, 2005, CERVICAL SPINE, P1135
[3]   INSTABILITY OF THE CERVICAL-SPINE AFTER DECOMPRESSION IN PATIENTS WHO HAVE ARNOLD-CHIARI MALFORMATION [J].
ARONSON, DD ;
KAHN, RH ;
CANADY, A ;
BOLLINGER, RO ;
TOWBIN, R .
JOURNAL OF BONE AND JOINT SURGERY-AMERICAN VOLUME, 1991, 73A (06) :898-906
[4]   Laminoplasty with foraminotomy for coexisting cervical myelopathy and unilateral radiculopathy - A preliminary report [J].
Baba, H ;
Chen, QX ;
Uchida, K ;
Imura, S ;
Morikawa, S ;
Tomita, K .
SPINE, 1996, 21 (02) :196-202
[5]   SPINAL DEFORMITY AFTER MULTIPLE-LEVEL CERVICAL LAMINECTOMY IN CHILDREN [J].
BELL, DF ;
WALKER, JL ;
OCONNOR, G ;
TIBSHIRANI, R .
SPINE, 1994, 19 (04) :406-411
[6]  
Bush K, 1996, Eur Spine J, V5, P319, DOI 10.1007/BF00304347
[7]   Cervical radiculopathy [J].
Carette, S ;
Fehlings, MG .
NEW ENGLAND JOURNAL OF MEDICINE, 2005, 353 (04) :392-399
[8]   Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy [J].
Fouyas, IP ;
Statham, PFX ;
Sandercock, PAG .
SPINE, 2002, 27 (07) :736-747
[9]   CERVICAL SPONDYLOTIC RADICULOPATHY AND MYELOPATHY - LONG-TERM FOLLOW-UP-STUDY [J].
GREGORIUS, FK ;
ESTRIN, T ;
CRANDALL, PH .
ARCHIVES OF NEUROLOGY, 1976, 33 (09) :618-625
[10]   Spinal deformity and instability after multilevel cervical laminectomy for spondylotic myelopathy [J].
Guigui, P ;
Benoist, M ;
Deburge, A .
SPINE, 1998, 23 (04) :440-447