Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
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The Effect of Uncinate Process Resection on Subsidence Following Anterior Cervical Discectomy and Fusion

  • Lee, Su Hun (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Lee, Jun Seok (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Sung, Soon Ki (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Son, Dong Wuk (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Lee, Sang Weon (Department of Neurosurgery, Pusan National University Yangsan Hospital) ;
  • Song, Geun Sung (Department of Neurosurgery, Pusan National University Yangsan Hospital)
  • Received : 2017.02.23
  • Accepted : 2017.04.19
  • Published : 2017.09.01
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Abstract

Objective : Subsidence is a frequent complication of anterior cervical discectomy and fusion. Postoperative segmental micromotion, thought to be a causative factor of subsidence, has been speculated to increase with uncinate process resection area (UPR). To evaluate the effect of UPR on micro-motion, we designed a method to measure UPR area based on pre- and postoperative computed tomography images and analyzed the relationship between UPR and subsidence as a proxy of micro-motion. Methods : We retrospectively collected clinical and radiological data from January 2011 to June 2016. A total of 38 patients (53 segments) were included. All procedures included bilateral UPR and anterior plate fixation. UPR area was evaluated with reformatted coronal computer tomography images. To reduce level-related bias, we converted UPR area to the proportion of UPR to the pre-operative UP area (pUPR). Results : Subsidence occurred in 18 segments (34%) and positively correlated with right-side pUPR, left-side pUPR, and the sum of bilateral pUPR (sum pUPR) (R=0.310, 301, 364; p=0.024, 0.029, 0.007, respectively). Multiple linear regression analysis revealed that subsidence could be estimated with the following formula : $subsidence=1.522+2.7{\times}sum\;pUPR$($R^2=0.133$, p=0.007). Receiver-operating characteristic analysis determined that sum $pUPR{\geq}0.38$ could serve as a threshold for significantly increased risk of subsidence (p=0.005, area under curve=0.737, sensitivity=94%, specificity=51%). This threshold was confirmed by logistic regression analysis for subsidence (p=0.009, odds ratio=8.471). Conclusion : The UPR measurement method confirmed that UPR was correlated with subsidence. Particularly when the sum of pUPR is ${\geq}38%$, the possibility of subsidence increased.

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References

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