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Feasibility of Posterior Cervical Foraminotomy for Adjacent Segmental Disease after Anterior Cervical Fusion

Journal of Korean Neurosurgical Society 2020년 63권 6호 p.767 ~ 776
김현준, 강민수, 이상호, 박찬홍, 정석원, 신용환, 이신영, 박은수,
소속 상세정보
김현준 ( Kim Hyun-Jun ) - Daegu Wooridul Spine Hospital Department of Neurosurgery
강민수 ( Kang Min-Soo ) - Daegu Wooridul Spine Hospital Department of Neurosurgery
이상호 ( Lee Sang-Ho ) - Wooridul Spine Hospital Department of Neurosurgery
박찬홍 ( Park Chan-Hong ) - Daegu Wooridul Spine Hospital Department of Anesthesiology and Pain Medicine
정석원 ( Chung Seok-Won ) - Daegu Wooridul Spine Hospital Department of Neurosurgery
신용환 ( Shin Yong-Hwan ) - Daegu Wooridul Spine Hospital Department of Neurosurgery
이신영 ( Lee Shin-Young ) - Daegu Wooridul Spine Hospital Department of Neurosurgery
박은수 ( Park Eun-Soo ) - Daegu Wooridul Spine Hospital Department of Neurosurgery

Abstract


Objective: The aim of this study is to evaluate the feasibility of posterior cervical foraminotomy (PCF) for adjacent segmental disease (ASD) after anterior cervical fusion (ACF). As ACF is accepted as the standard treatment for cervical spondylosis, many studies have been conducted to evaluate the efficacy of various surgical techniques to overcome symptomatic ASD after the previous surgery. Herein, PCF was performed for the treatment of symptomatic ASD and the feasibility of the surgery was evaluated.

Methods: Forty nine patients who underwent PCF due to symptomatic ASD from August 2008 to November 2017 were identified. For demographic and perioperative data, the sex, age, types of previous surgery, ASD levels, operation times, and bleeding amount were recorded. The clinical outcome was assessed using the visual analogue scale for the neck and arm, the modified Odom’s criteria as well as neck disability index. Radiologic evaluations were performed by measuring disc softness, disc height, the cervical 2-7 sagittal vertical axis, cervical cobb angle, and facet violation.

Results: Thirty-seven patients were enrolled in this study. The patients were divided into two groups based on the location of the pathology; paracentral (group P) or foramina (group F). Both groups showed significant clinical improvement (p<0.05). The proportion of calcified disc and facet violations was significantly larger in group F (p<0.05). The minimal disc height decrease with mild improvement on sagittal alignment and cervical lordosis was radiologically measured without statistical significance in both groups (p>0.05).

Conclusion: PCF showed satisfactory clinical and radiologic outcomes for both paracentral and foraminal pathologies of ASD after ACF. Complications related to anterior revision were also avoided. PCF can be considered a feasible and safe surgical option for ASD after ACF.

키워드

Minimaly invasive surgery; Revision surgery; Foraminotomy; Radiculopathy

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