Analysis of the morphometric change in the uncinate process of the cervical spondylosis patients: A study of radiological anatomy

Cui, Shangbin; Nasser, Al-Attar E.; Ma, Ling; Su, Peiqiang; Su, Deying; Liao, Zhiheng

doi:10.1016/j.jot.2020.03.011

Cited by 6 publications

(6 citation statements)

References 15 publications

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“…As the uncinate process is a structure that supports the cranial vertebral body, its height is expected to be similar to the intervertebral disc height. 34,35 Cui et al 24 reported that despite the decrease in uncinate process height during degeneration, the difference between the non-degenerated segments and spondylosis segments is small (~1 mm). Therefore, the uncinate height, even in segments with degeneration, would approximate the normal disc height.…”

Section: Discussionmentioning

confidence: 99%

Which Radiographic Parameter Can Aid in Deciding Optimal Allograft Height for Anterior Cervical Discectomy and Fusion?

Yang

Park²,

Kim³

2023

Clinical Spine Surgery: A Spine Publication

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Study Design: Retrospective cohort study. Objectives: To identify preoperative radiographic parameters that can guide optimal allograft height selection for anterior cervical discectomy and fusion (ACDF). Summary of Background Data: Allograft height selection for ACDF depends on intraoperative assessment supported by trials; however, there is currently no radiographic reference parameter that could aid in allograft height selection for improved outcomes. Methods: A total of 148 patients who underwent ACDF using allografts and were followed up for more than 1 year were retrospectively reviewed. Fusion rates, subsidence, segmental lordosis, and foraminal height were assessed. Segments were divided into 2 groups according to whether the inserted allograft height was within 1 mm from the following 3 reference radiographic parameters: (1) uncinate process height, (2) adjacent disc height, and (3) preoperative disc height +2 mm. Results: This study included 101 patients with 163 segments. Segments with an allograft-uncinate height difference of ≤1 mm had a significantly higher fusion rate at 1-year follow-up compared with segments with allograft-uncinate height difference of >1 mm [85/107 (79.4%) vs. 35/56 (62.5%); P=0.025]. Subsidence, segmental lordosis, and foraminal height did not significantly differ between the groups when segments were divided according to uncinate height. Multivariate logistic regression analysis demonstrated that allograft-uncinate height difference of ≤1 mm and allograft failure were factors associated with fusion. Conclusions: The uncinate process height can guide optimal allograft height selection for ACDF. Using an allograft with an allograft-uncinate height difference of ≤1 mm resulted in a higher fusion rate. Therefore, the uncinate process height should be checked preoperatively and used in conjunction with intraoperative assessment when selecting allograft height.

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Section: Discussionmentioning

confidence: 99%

Which Radiographic Parameter Can Aid in Deciding Optimal Allograft Height for Anterior Cervical Discectomy and Fusion?

Yang

Park²,

Kim³

2023

Clinical Spine Surgery: A Spine Publication

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“…The UAM-to-RT distance required for adequate decompression was 1.6-mm at C3–C4 and gradually increased at each distal level. This increasing trend could be attributed to the increased horizontal distance between uncinate processes at more distal levels [ 22 ]. We assumed that self-retractors are placed at the uncinate process, limiting the angulation of the surgical instruments; therefore, fewer angulations would be possible at proximal levels, and greater anterior bone removal would be required for sufficient bone resection at the posterior uncinate.…”

Section: Discussionmentioning

confidence: 99%

“…Uncovertebral joints with grade ≥2 were classified as “uncinate degeneration.” Coronal CT images were used to measure uncinate process height (distance from the line from the upper endplate of the vertebral body to the tip of the uncinate process) and uncinate process thickness (distance between the medial and lateral borders of the uncinate process at the plane of the upper endplate) ( Fig. 1A ) [ 22 ]. Furthermore, anteroposterior length, as the vertical distance between the anterior and posterior borders of the uncinate process, vertical distance from the baseline plane of the uncinate process to the VA, horizontal distance from the lateral border of the uncinate process to the VA, and horizontal distance between the right and left tips of the uncinate process, were measured based on axial CT images ( Fig.…”

Section: Methodsmentioning

confidence: 99%

Preoperative Radiographic Simulation for Partial Uncinate Process Resection during Anterior Cervical Discectomy and Fusion to Achieve Adequate Foraminal Decompression and Prevention of Vertebral Artery Injury

Yang,

Kim,

Lee

et al. 2023

Asian Spine J

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Study Design: Retrospective radiographic study.Purpose: This study aims to demonstrate the proper resection trajectory of a partial posterior uncinate process resection combined with anterior cervical discectomy and fusion (ACDF) and evaluate whether foraminal stenosis or uncinate process degeneration increases the risk of vertebral artery (VA) injury.Overview of Literature: Appropriate resection trajectory that could result in sufficient decompression and avoid vertebral artery injury is yet unknown.Methods: We retrospectively reviewed patients who underwent cervical magnetic resonance imaging and computed tomography angiography for preoperative ACDF evaluation. The segments were classified according to the presence of foraminal stenosis. The height, thickness, anteroposterior length, horizontal distance from the uncinate process to the VA, and vertical distance from the uncinate process baseline to the VA of the uncinate process were measured. The distance between the uncinate anterior margin and the resection trajectory (UAM-to-RT) was measured.Results: There were no VA injuries or root injuries among the 101 patients who underwent ACDF (163 segments, mean age of 56.3±12.2). Uncinate anteroposterior length was considerably longer in foramens with foraminal stenosis, whereas uncinate process height, thickness, and distance between the uncinate process and VA were not significantly associated with foraminal stenosis. There were no significant differences in radiographic parameters based on uncinate degeneration. The UAM-to-RT distances for adequate decompression were 1.6±1.4 mm (range, 0–4.8 mm), 3.4±1.7 mm (range, 0–7.1 mm), 4.0±1.7 mm (range, 0–9.0 mm), and 4.5±1.2 mm (range, 2.5–7.5 mm) for C3–C4, C4–C5, C5–C6, and C6–C7, respectively.Conclusions: More than half of the uncinate process in the anteroposterior plane should be removed for adequate neural foramen decompression. Foraminal stenosis or uncinate degeneration did not alter the relative anatomy of the uncinate process and the VA and did not impact VA injury risk.

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“…ACCF has been widely used for the treatment of CSM [ 5 ]. Solid fusion and decompression to the spinal cord have been considered successful outcomes of this procedure [ 6 , 21 ]; however ACCF is, in fact, the second-best choice when corpectomy must be performed for decompression and anterior fusion must be achieved to maintain a stable biomechanical environment. In theory, the loss of motion of the operative levels resulting from rigid fusion redistributes into adjacent segments [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…Cervical spondylotic myelopathy (CSM), which can cause spinal cord injury, is a common disease with several therapeutic options [ [1] , [2] , [3] ]. Anterior cervical corpectomy and fusion (ACCF) is an effective treatment for CSM [ [4] , [5] , [6] , [7] ]. This procedure usually fuses three or more cervical vertebrae by using an anterior plate and bone graft or titanium mesh cage after decompression by corpectomy [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Biomechanics of a novel artificial cervical vertebra from an in vivo caprine cervical spine non-fusion model

Dong

Liang

Sun

et al. 2022

Journal of Orthopaedic Translation

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Analysis of the morphometric change in the uncinate process of the cervical spondylosis patients: A study of radiological anatomy

Cited by 6 publications

References 15 publications

Which Radiographic Parameter Can Aid in Deciding Optimal Allograft Height for Anterior Cervical Discectomy and Fusion?

Which Radiographic Parameter Can Aid in Deciding Optimal Allograft Height for Anterior Cervical Discectomy and Fusion?

Preoperative Radiographic Simulation for Partial Uncinate Process Resection during Anterior Cervical Discectomy and Fusion to Achieve Adequate Foraminal Decompression and Prevention of Vertebral Artery Injury

Biomechanics of a novel artificial cervical vertebra from an in vivo caprine cervical spine non-fusion model

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