Journal of Korean Neurosurgical Society

  • 제56권2호
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  • Pages.114-120
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  • 2014
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  • 2005-3711(pISSN)
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  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
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Cervical Cord Decompression Using Extended Anterior Cervical Foraminotomy Technique

  • Kim, Sung-Duk (Department of Neurosurgery, Konyang University Hospital) ;
  • Ha, Ho-Gyun (Department of Neurosurgery, Konyang University Hospital) ;
  • Lee, Cheol-Young (Department of Neurosurgery, Konyang University Hospital) ;
  • Kim, Hyun-Woo (Department of Neurosurgery, Konyang University Hospital) ;
  • Jung, Chul-Ku (Department of Neurosurgery, Konyang University Hospital) ;
  • Kim, Jong Hyun (Department of Neurosurgery, Konyang University Hospital)
  • 투고 : 2014.03.07
  • 심사 : 2014.08.16
  • 발행 : 2014.08.28
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초록

Objective : At present, gold-standard technique of cervical cord decompression is surgical decompression and fusion. But, many complications related cervical fusion have been reported. We adopted an extended anterior cervical foraminotomy (EACF) technique to decompress the anterolateral portion of cervical cord and report clinical results and effectiveness of this procedure. Methods : Fifty-three patients were operated consecutively using EACF from 2008 to 2013. All of them were operated by a single surgeon via the unilateral approach. Twenty-two patients who exhibited radicular and/or myelopathic symptoms were enrolled in this study. All of them showed cervical cord compression in their preoperative magnetic resonance scan images. Results : In surgical outcomes, 14 patients (64%) were classified as excellent and six (27%), as good. The mean difference of cervical cord anterior-posterior diameter after surgery was 0.92 mm (p<0.01) and transverse area was $9.77mm^2$ (p<0.01). The dynamic radiological study showed that the average post-operative translation (retrolisthesis) was 0.36 mm and the disc height loss at the operated level was 0.81 mm. The change in the Cobb angle decreased to 3.46, and showed slight kyphosis. The average vertebral body resection rate was 11.47%. No procedure-related complications occurred. Only one patient who had two-level decompression needed anterior fusion at one level as a secondary surgery due to postoperative instability. Conclusions : Cervical cord decompression was successfully performed using EACF technique. This procedure will be an alternative surgical option for treating cord compressing lesions. Long-term follow-up and a further study in larger series will be needed.

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참고문헌

  1. Batzdorf U, Batzdorff A : Analysis of cervical spine curvature in patients with cervical spondylosis. Neurosurgery 22 : 827-836, 1988 https://doi.org/10.1227/00006123-198805000-00004
  2. Chacko AG, Joseph M, Turel MK, Prabhu K, Daniel RT, Jacob KS : Multilevel oblique corpectomy for cervical spondylotic myelopathy preserves segmental motion. Eur Spine J 21 : 1360-1367, 2012 https://doi.org/10.1007/s00586-011-2137-3
  3. Chacko AG, Turel MK, Sarkar S, Prabhu K, Daniel RT : Clinical and radiological outcomes in 153 patients undergoing oblique corpectomy for cervical spondylotic myelopathy. Br J Neurosurg 28 : 49-55, 2014 https://doi.org/10.3109/02688697.2013.815326
  4. Chen TY, Crawford NR, Sonntag VK, Dickman CA : Biomechanical effects of progressive anterior cervical decompression. Spine (Phila Pa 1976) 26 : 6-13; discussion 14, 2001 https://doi.org/10.1097/00007632-200101010-00003
  5. Clarke E, Robinson PK : Cervical myelopathy : a complication of cervical spondylosis. Brain 79 : 483-510, 1956 https://doi.org/10.1093/brain/79.3.483
  6. Hacker RJ, Miller CG : Failed anterior cervical foraminotomy. J Neurosurg 98 (2 Suppl) : 126-130, 2003
  7. Haden N, Latimer M, Seeley HM, Laing RJ : Loss of inter-vertebral disc height after anterior cervical discectomy. Br J Neurosurg 19 : 469-474, 2005 https://doi.org/10.1080/02688690500495109
  8. Jho HD : Decompression via microsurgical anterior foraminotomy for cervical spondylotic myelopathy. Technical note. J Neurosurg 86 : 297-302, 1997 https://doi.org/10.3171/jns.1997.86.2.0297
  9. Jho HD, Kim MH, Kim WK : Anterior cervical microforaminotomy for spondylotic cervical myelopathy : part 2. Neurosurgery 51 (5 Suppl) : S54-S59, 2002
  10. Jho HD, Kim WK, Kim MH : Anterior microforaminotomy for treatment of cervical radiculopathy : part 1--disc-preserving "functional cervical disc surgery". Neurosurgery 51 (5 Suppl) : S46-S53, 2002
  11. Jung SS, Chung JC, Park KS, Chung SY, Park MS, Ha HG. : Long-term follow-up results of anterior cervical microforaminotomy. Korean J Spine 7 : 66-72, 2010
  12. Kalsi-Ryan S, Karadimas SK, Fehlings MG : Cervical spondylotic myelopathy : the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist 19 : 409-421, 2013 https://doi.org/10.1177/1073858412467377
  13. Kim JG, Kim SW, Lee SM, Shin H : Surgical result of the combined anterior and posterior approach in treatment of cervical spondylotic myelopathy. J Korean Neurosurg Soc 3 : 188-191, 2006
  14. Kim MH : Clinical and radiological long-term outcomes of anterior microforaminotomy for cervical degenerative disease. Spine (Phila Pa 1976) 38 : 1812-1819, 2013 https://doi.org/10.1097/BRS.0b013e31827ddd9e
  15. Kim YG, Lee JS, Park MS, Ha HG : Midterm follow-up results of anterior cervical microforaminotomy. J Korean Neurosurg Soc 35 : 250-255, 2004
  16. Kotani Y, McNulty PS, Abumi K, Cunningham BW, Kaneda K, McAfee PC : The role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine. A biomechanical study. Spine (Phila Pa 1976) 23 : 1559-1565, 1998 https://doi.org/10.1097/00007632-199807150-00011
  17. Lebl DR, Hughes A, Cammisa FP Jr, O'Leary PF : Cervical spondylotic myelopathy : pathophysiology, clinical presentation, and treatment. HSS J 7 : 170-178, 2011 https://doi.org/10.1007/s11420-011-9208-1
  18. Oh SH, Perin NI, Cooper PR : Quantitative three-dimensional anatomy of the subaxial cervical spine : implication for anterior spinal surgery. Neurosurgery 38 : 1139-1144, 1996
  19. White AA 3rd, Johnson RM, Panjabi MM, Southwick WO : Biomechanical analysis of clinical stability in the cervical spine. Clin Orthop Relat Res (109) : 85-96, 1975
  20. Wu XD, Yuan W, Chen HJ, Chen Y, Wang JX, Cao P, et al. : Neck motion following multilevel anterior cervical fusion : comparison of short-term and midterm results. J Neurosurg Spine 18 : 362-366, 2013 https://doi.org/10.3171/2013.1.SPINE12638
  21. Yang HL, Chen GD, Zhang HT, Wang L, Luo ZP : Open-door laminoplasty with plate fixation at alternating levels for treatment of multilevel degenerative cervical disease. J Spinal Disord Tech 26 : E13-E18, 2013 https://doi.org/10.1097/BSD.0b013e31827844cd
  22. Zhu B, Xu Y, Liu X, Liu Z, Dang G : Anterior approach versus posterior approach for the treatment of multilevel cervical spondylotic myelopathy : a systemic review and meta-analysis. Eur Spine J 22 : 1583-1593, 2013 https://doi.org/10.1007/s00586-013-2817-2