Does Additional Uncinate Resection Increase Pseudarthrosis Following Anterior Cervical Discectomy and Fusion?

Lee, Dong‐Ho; Cho, Jae-Hwan; Baik, Jong-Min; Joo, Youn-Suk; Park, Sehan; Min, Woo‐Kie; Hwang, Chang Ju; Lee, Choon Sung

doi:10.1097/brs.0000000000002271

Cited by 31 publications

(30 citation statements)

References 15 publications

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“…Many patients with cervical radiculopathy also experience stenosis of the neural foramens because of cumulative osteophyte or uncovertebral joint hypertrophy. Although most anterior cervical discectomy and fusion procedures include cervical uncosectomy or uncoforaminotomy to decompress nerve roots in patients with cervical radiculopathy, Lee DH et al reported that complete uncinate process resection (UPR) during ACDF improves pain in a patient's arm more rapidly than conventional ACDF without UPR and provides similar fusion rates [3,4]. Meanwhile, SH Lee et al reported that complete UPR over 38% during ACDF increases the risk of subsidence during follow up [5].…”

Section: Introductionmentioning

confidence: 99%

Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion

Noh

Park

Kuh

et al. 2020

BMC Musculoskelet Disord

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Background: Many patients with cervical radiculopathy experience stenosis of the neural foramens due to cumulative osteophyte or uncovertebral joint hypertrophy. For cervical foraminal stenosis, complete uncinate process resection (UPR) is often conducted concurrently with anterior discectomy and fusion (ACDF). The aim of this study was to assess the clinical and radiological outcomes of ACDF with complete UPR versus ACDF without UPR. Methods: In total, 105 patients who performed one-level ACDF with a cage-and-plate construct between 2011 and 2015 were retrospectively reviewed. Among them, 37 patients had ACDF with complete UPR, and 68 patients had ACDF without UPR. Radiologic outcomes of disc height, C2-C7 lordosis, T1 slope, C2-C7 sagittal vertical axis (SVA), center of the sella turcica-C7 SVA (St-SVA), spino-cranial angle (SCA), and fusion rate were evaluated on plain X-ray at pre-operation, immediately post-operation, and at 2-year follow-up. For statistically matched pairs analysis, ACDF with UPR group (24 patients) and ACDF without UPR (24 patients) were compared. Results: All of the clinical parameters improved at the 2-year follow up (P < 0.0001). Improvement in visual analogue scale (VAS) scores for arm pain was significantly improved in the ACDF with complete UPR group immediately postoperation. All cervical sagittal parameters, including cervical lordosis, segmental angle, disc height, C2-C7 SVA, St-SVA, T1 slope, and SCA, except for preoperative St-SVA, SCA, and disc height of 2 years follow-up, were similar between the ACDF with complete UPR and ACDF without UPR groups. Differences in disc height, C2-C7 SVA, and SCA at 2-year follow up after preoperative examination, however, were statistically significant (p < 0.05). Subsidence occurred in 9 patients (ACDF with complete UPR: 8 cases [33%] versus ACDF without UPR: 1 cases [4%]; p < 0.05).

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Section: Introductionmentioning

confidence: 99%

Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion

Noh

Park

Kuh

et al. 2020

BMC Musculoskelet Disord

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“…During anterior arthrodesis, plate fixation was associated with significantly higher vertebral fusion rates (95% confidence interval [CI], 1.16–3.37), lower subsidence rates (95% CI, 0.18–0.52), and more favorable scores in the Visual Analog Scale for neck pain [ 43 ]. For the decompression of the combined radiculopathy, additional unilateral or bilateral resection of the uncinate process during anterior cervical discectomy and fusion (ACDF) was reported to have not affected the fusion rate after single- or double-level ACDF [ 44 ]. For the decompression of multilevel spinal stenosis, various anterior decompressive surgical techniques have been introduced for multilevel ACDF, corpectomy, and hybrid surgery.…”

Section: Anterior Surgerymentioning

confidence: 99%

Degenerative Cervical Myelopathy: Pathophysiology and Current Treatment Strategies

Choi

Kang

2020

Asian Spine J

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Chronic compression or ischemia of the spinal cord in the cervical spine causes a clinical syndrome known as cervical myelopathy. Recently, a new term “degenerative cervical myelopathy (DCM)” was introduced. DCM encompasses spondylosis, intervertebral disk herniation, facet arthrosis, ligamentous hypertrophy, calcification, and ossification. The pathophysiology of DCM includes structural and functional abnormalities of the spinal cord caused by static and dynamic factors. In nonoperative patients, cervical myelopathy has a poor prognosis. Surgical treatments, such as anterior or posterior decompression accompanying arthrodesis, arthroplasty, or laminoplasty, should be considered for patients with chronic progressive cervical myelopathy. Surgical decompression can prevent the progression of myelopathy and improve the neurologic status, functional outcomes, and quality of life, irrespective of differences in medical systems and sociocultural determinants of health. The anterior surgical approach to the cervical spine has the advantage of removing or floating the intervertebral disk, osteophytes, and ossification of the posterior longitudinal ligament that compress the spinal cord directly. The posterior surgical approach to the cervical spine is mainly used for multisegment spinal cord compression in patients with cervical lordosis. In this review article, we addressed the pathophysiology, clinical manifestations, differential diagnosis, and treatment options for DCM.

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Section: Introductionmentioning

confidence: 99%

Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion

Noh¹,

Park

Kuh

et al. 2020

Preprint

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Background: Many patients with cervical radiculopathy experience stenosis of the neural foramens due to cumulative osteophyte or uncovertebral joint hypertrophy. For cervical foraminal stenosis, complete uncinate process resection (UPR) is often conducted concurrently with anterior discectomy and fusion (ACDF). The aim of this study was to assess the clinical and radiological outcomes of ACDF with complete UPR versus ACDF without UPR. Methods: In total, 105 patients who performed one-level ACDF with a cage-and-plate construct between 2011 and 2015 were retrospectively reviewed. Among them, 37 patients had ACDF with complete UPR, and 68 patients had ACDF without UPR. Radiologic outcomes of disc height, C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis (SVA), center of the sella turcica–C7 SVA (St-SVA), spino-cranial angle (SCA), and fusion rate were evaluated on plain X-ray at pre-operation, immediately post-operation, and at 2-year follow-up. For statistically matched pairs analysis, ACDF with UPR group (24 patients) and ACDF without UPR (24 patients) were compared. Results: All of the clinical parameters improved at the 2-year follow up (P<0.0001). Improvement in visual analogue scale (VAS) scores for arm pain was significantly improved in the ACDF with complete UPR group immediately post-operation. All cervical sagittal parameters, including cervical lordosis, segmental angle, disc height, C2-C7 SVA, St-SVA, T1 slope, and SCA, except for preoperative St-SVA, SCA, and disc height of 2 years follow-up, were similar between the ACDF with complete UPR and ACDF without UPR groups. Differences in disc height, C2-C7 SVA, and SCA at 2-year follow up after preoperative examination, however, were statistically significant (p<0.05). Subsidence occurred in 9 patients (ACDF with complete UPR: 8 cases [33%] versus ACDF without UPR: 1 cases [4%]; p < 0.05). Conclusions: Cervical sagittal alignment after ACDF with complete UPR is not significantly different from that achieved with ACDF without UPR. However, subsidence appears to occur more often after ACDF with complete UPR than after ACDF without UPR, although with little to no clinical impact. More precise and careful selection of patients is needed when deciding on additional complete UPR.

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Does Additional Uncinate Resection Increase Pseudarthrosis Following Anterior Cervical Discectomy and Fusion?

Abstract: 4.

Cited by 31 publications

References 15 publications

Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion

Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion

Degenerative Cervical Myelopathy: Pathophysiology and Current Treatment Strategies

Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion

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