Journal of Korean Neurosurgical Society

The Korean Neurosurgical Society (대한신경외과학회)
권호 표지
DOI QR코드

DOI QR Code

Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

  • Lee, Subum (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Cho, Dae-Chul (Department of Neurosurgery, Kyungpook National University Hospital) ;
  • Chon, Haemin (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Roh, Sung Woo (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Il (Department of Neurosurgery, Dongtan Sacred Heart Hospital, University of Hallym University) ;
  • Park, Jin Hoon (Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2020.09.04
  • Accepted : 2020.10.28
  • Published : 2021.07.01
Download PDF
⟨ Previous Next ⟩

Abstract

Objective : To compare the anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) with wide facetectomy in the treatment of parallel-shaped bony foraminal stenosis (FS). Methods : Thirty-six patients underwent surgery due to one-or-two levels of parallel-shaped cervical FS. ACDF was performed in 16 patients, and PCF using CPS was performed in 20 patients. All patients were followed up at 1, 3, 6, and 12 months postoperatively. Standardized outcome measures such as Numeric rating scale (NRS) score for arm/neck pain and Neck disability index (NDI) were evaluated. Cervical radiographs were used to compare the C2-7 Cobb's angle, segmental angle, and fusion rates. Results : There was an improvement in NRS scores after both approaches for radicular arm pain (mean change -6.78 vs. -8.14, p=0.012), neck pain (mean change -1.67 vs. -4.36, p=0.038), and NDI score (-19.69 vs. -18.15, p=0.794). The segmental angle improvement was greater in the ACDF group than in the posterior group (9.4°±2.7° vs. 3.3°±5.1°, p=0.004). However, there was no significant difference in C2-7 Cobb angle between groups (16.2°±7.9° vs. 14.8°±8.5°, p=0.142). As a complication, dysphagia was observed in one case of the ACDF group. Conclusion : In the treatment of parallel-shaped bony FS up to two surgical levels, segmental angle improvement was more favorable in patients who underwent ACDF. However, PCF with wide facetectomy using CPS should be considered as an alternative treatment option in cases where the anterior approach is burdensome.

Keywords

References

  1. Abumi K : Cervical spondylotic myelopathy: posterior decompression and pedicle screw fixation. Eur Spine J 24 Suppl 2 : 186-196, 2015 https://doi.org/10.1007/s00586-015-3838-9
  2. Abumi K, Ito M, Sudo H : Reconstruction of the subaxial cervical spine using pedicle screw instrumentation. Spine (Phila Pa 1976) 37 : E349-E356, 2012 https://doi.org/10.1097/BRS.0b013e318239cf1f
  3. Ames CP, Smith JS, Scheer JK, Shaffrey CI, Lafage V, Deviren V, et al. : A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction: clinical article. J Neurosurg Spine 19 : 269-278, 2013 https://doi.org/10.3171/2013.5.SPINE121067
  4. Bartolomei J, Sonntag V : Anterior approach including cervical corpectomy in Winn HR, Youmans JR (eds) : Youmans Neurological Surgery, ed 5. Philadelphia : Saunders, 2004, pp4431-4445
  5. Chon H, Park JH : Cervical vertebral body fracture with ankylosing spondylitis treated with cervical pedicle screw: a fracture body overlapping reduction technique. J Clin Neurosci 41 : 150-153, 2017 https://doi.org/10.1016/j.jocn.2017.04.012
  6. Cunningham BW, Sefter JC, Shono Y, McAfee PC : Static and cyclical biomechanical analysis of pedicle screw spinal constructs. Spine (Phila Pa 1976) 18 : 1677-1688, 1993 https://doi.org/10.1097/00007632-199309000-00017
  7. Dodwad SJ, Dodwad SN, Prasarn ML, Savage JW, Patel AA, Hsu WK : Posterior cervical foraminotomy: indications, technique, and outcomes. Clin Spine Surg 29 : 177-185, 2016 https://doi.org/10.1097/BSD.0000000000000384
  8. Fessler RG, Khoo LT : Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery 51(5 Suppl) : S37-S45, 2002
  9. Gu BS, Choi SJ, Yoo B, Han KH, Park JK, Lee YS, et al. : An incidental finding of a radiopaque pill following cervical spinal surgery in a Parkinson's disease patient. Korean J Spine 12 : 153-155, 2015 https://doi.org/10.14245/kjs.2015.12.3.153
  10. Gu BS, Park JH, Seong HY, Jung SK, Roh SW : Feasibility of posterior cervical foraminotomy in cervical foraminal stenosis: prediction of surgical outcomes by the foraminal shape on preoperative computed tomography. Spine (Phila Pa 1976) 42 : E267-E271, 2017 https://doi.org/10.1097/BRS.0000000000001785
  11. Gutman G, Rosenzweig DH, Golan JD : Surgical treatment of cervical radiculopathy: meta-analysis of randomized controlled trials. Spine (Phila Pa 1976) 43 : E365-E372, 2018 https://doi.org/10.1097/BRS.0000000000002324
  12. Hasegawa K, Hirano T, Shimoda H, Homma T, Morita O : Indications for cervical pedicle screw instrumentation in nontraumatic lesions. Spine (Phila Pa 1976) 33 : 2284-2289, 2008 https://doi.org/10.1097/BRS.0b013e31818043ce
  13. Heo Y, Lee SB, Lee BJ, Jeong SK, Rhim SC, Roh SW, et al. : The learning curve of subaxial cervical pedicle screw placement: how can we avoid neurovascular complications in the initial period? Oper Neurosurg (Hagerstown) 17 : 603-607, 2019 https://doi.org/10.1093/ons/opz070
  14. Johnston TL, Karaikovic EE, Lautenschlager EP, Marcu D : Cervical pedicle screws vs. lateral mass screws: uniplanar fatigue analysis and residual pullout strengths. Spine J 6 : 667-672, 2006 https://doi.org/10.1016/j.spinee.2006.03.019
  15. Kang MS, Choi KC, Lee CD, Shin YH, Hur SM, Lee SH : Effective cervical decompression by the posterior cervical foraminotomy without discectomy. J Spinal Disord Tech 27 : 271-276, 2014 https://doi.org/10.1097/BSD.0b013e3182a35707
  16. Kerry G, Hammer A, Ruedinger C, Ranaie G, Steiner HH : Microsurgical posterior cervical foraminotomy: a study of 181 cases. Br J Neurosurg 31 : 39-44, 2017 https://doi.org/10.1080/02688697.2016.1206184
  17. Kim HB, Lee MK, Lee YS, Sohn JY, Jung SK, Park JH : An assessment of the medial angle of inserted subaxial cervical pedicle screw during surgery: practical use of preoperative CT scanning and intraoperative X-rays. Neurol Med Chir (Tokyo) 57 : 159-165, 2017 https://doi.org/10.2176/nmc.oa.2016-0161
  18. Lee DH, Cho JH, Baik JM, Joo YS, Park S, Min WK, et al. : Does additional uncinate resection increase pseudarthrosis following anterior cervical discectomy and fusion? Spine (Phila Pa 1976) 43 : 97-104, 2018 https://doi.org/10.1097/BRS.0000000000002271
  19. Lee JK, Jung SK, Lee YS, Jeon SR, Roh SW, Rhim SC, et al. : Analysis of the fusion and graft resorption rates, as measured by computed tomography, 1 year after posterior cervical fusion using a cervical pedicle screw. World Neurosurg 99 : 171-178, 2017 https://doi.org/10.1016/j.wneu.2016.12.027
  20. Lee S, Jung SK, Kim HB, Roh SW, Jeon SR, Park JH : Postoperative non-pathological fever following posterior cervical fusion surgery : is laminoplasty a better preventive method than laminectomy? J Korean Neurosurg Soc 63 : 487-494, 2020 https://doi.org/10.3340/jkns.2019.0191
  21. Lee S, Seo J, Lee MK, Jeon SR, Roh SW, Rhim SC, et al. : Widening of the safe trajectory range during subaxial cervical pedicle screw placement: advantages of a curved pedicle probe and laterally located starting point without creating a funnel-shaped hole. J Neurosurg Spine 27 : 150-157, 2017 https://doi.org/10.3171/2016.12.SPINE16738
  22. Lee SH, Lee JS, Sung SK, Son DW, Lee SW, Song GS : The effect of uncinate process resection on subsidence following anterior cervical discectomy and fusion. J Korean Neurosurg Soc 60 : 550-559, 2017 https://doi.org/10.3340/jkns.2017.0202.014
  23. Nakagawa H, Saito K, Mitsugi T, Yagi K, Kanno A : Microdiscectomy and foraminotomy in cervical spondylotic myelopathy and radiculopathy: anterior versus posterior, microendoscopic surgery versus mini-open microsurgery. World Neurosurg 81 : 292-293, 2014 https://doi.org/10.1016/j.wneu.2013.01.122
  24. Pakzaban P : Ultrasonic total uncinectomy: a novel technique for complete anterior decompression of cervical nerve roots. Neurosurgery 10 Suppl 4 : 535-541; discussion 541, 2014
  25. Park JH, Jeon SR, Roh SW, Kim JH, Rhim SC : The safety and accuracy of freehand pedicle screw placement in the subaxial cervical spine: a series of 45 consecutive patients. Spine (Phila Pa 1976) 39 : 280-285, 2014 https://doi.org/10.1097/BRS.0000000000000133
  26. Park JH, Roh SW, Rhim SC : A single-stage posterior approach with open reduction and pedicle screw fixation in subaxial cervical facet dislocations. J Neurosurg Spine 23 : 35-41, 2015 https://doi.org/10.3171/2014.11.SPINE14805
  27. Park JH, Roh SW, Rhim SC : Response. J Neurosurg Spine 24 : 673, 2016 https://doi.org/10.3171/2014.9.SPINE14819
  28. Polly DW Jr, Klemme WR, Cunningham BW, Burnette JB, Haggerty CJ, Oda I : The biomechanical significance of anterior column support in a simulated single-level spinal fusion. J Spinal Disord 13 : 58-62, 2000 https://doi.org/10.1097/00002517-200002000-00012
  29. Rho YJ, Choe WJ : Double crush syndrome caused by cervical spondylosis and vertebral artery loop. Eur Spine J 28 : 292-296, 2019 https://doi.org/10.1007/s00586-017-5064-0
  30. Roh SW, Kim DH, Cardoso AC, Fessler RG : Endoscopic foraminotomy using MED system in cadaveric specimens. Spine (Phila Pa 1976) 25 : 260-264, 2000 https://doi.org/10.1097/00007632-200001150-00019
  31. Tan LA, Riew KD, Traynelis VC : Cervical spine deformity-part 3: posterior techniques, clinical outcome, and complications. Neurosurgery 81 : 893-898, 2017 https://doi.org/10.1093/neuros/nyx477
  32. Zeidman SM, Ducker TB : Posterior cervical laminoforaminotomy for radiculopathy: review of 172 cases. Neurosurgery 33 : 356-362, 1993 https://doi.org/10.1097/00006123-199309000-00002