微创前路经上位椎体椎间孔减压术治疗神经根型颈椎病

Transcorporeal anterior cervical microforaminotomy for cervical radiculopathy

目的：探讨微创前路经上位椎体椎间iL减压术治疗神经根型颈椎病的有效性。方法：2008年7月～2010年7月12例单侧神经根型颈椎病患者在延边大学医院接受微创前路经上位椎体椎间孔减压术。其中男7例，女5例．年龄为35～68岁，平均49岁。椎间孔狭窄部位：C5／64例，C6／75例，C7／T13例。软性髓核突m3例，钩椎关节骨质增生7例，突出的髓核钙化2例。均行前路手术，术中采用脊柱手术专用显微镜，在病变上位椎体确定钻孔起始部位．利用高速钻石气钻磨出一约6ram直径的通路达到病变区域，减压椎间孔。观察术前及末次随访时上肢放射性疼痛的VAS评分、颈椎功能障碍指数（NDI）及病变水平椎间盘高度。结果：手术时间为56～110min，平均86_＋6min；术中失血量为40～120ml，平均92＋8m1。无椎动脉损伤、贺纳氏综合征、喉返神经损伤等并发症。术后随访时间为12～23个月，平均15．8＋1-3个月。术前上肢疼痛VAS评分为8．5＋0．5分（7～lO分），末次随访时为1．4±0．2分（0～3分），两者比较有显著性差异（P〈0．05）；术前NDI为26．4±1．3分（22～31分），末次随访时为4-2±0．6分（3～8分），两者比较有显著性差异（P〈0．05），改善率为84．1％；术前病变水平椎间盘高度为5．4±0．7ram（4．2～6．1mm），末次随访时为4．9-＋0．7mm（3．6．5．8mm），两者比较无显著性差异（P〉0．05）。术后满意度为100％。结论：微创前路经上位椎体椎间7L减压术可减少对椎间盘的损伤，是治疗单侧神经根型颈椎病的有效手术方法。

Objectives： To investigate the effectiveness of transcorporeal anterior microforaminotomy for cervi- cal radiculopathy. Methods： Between July 2008 and July 2010, 12 patients underwent transcorporeal anterior mieroforaminotomy due to cervical radieulopathy. Among them, there were 7 males and 5 females, with a nman age of 49 years（range, 35-68 years）. The levels included C5/6 in 4 cases, C6/7 in 5 cases and C7/TI in 3 cases. The pathogenesis included soft nucleus pulposus herniation in 3 cases, uncovertebral joint osteo- proliferation in 7 cases and the calcification of protruded nucleus pulposus in 2 cases. During surgery, after soft tissue dissection, the entry point of drilling was determined on the upper vertebra of the diseased level under a spine surgical microscope. A hole about 6ram in diameter was made by using a high-speed air drill via the marked entry point. Drilling was conducted through the vertebral body to reach the lesion and subse- quent decompression was performed. Before smgery and at last follow-up, neck disability index（NDI）, visual analogue scale（VAS） for upper-extremity pain and the height of affected disc space were measured. Results： The mean operation time was 86_＋6rain（range, 56-110rain）, and the mean intraoperative blood loss was 92＋-8ml （range, 40-120ml）. No complication such as vertebral artery injury, Homer＇s syndrome or recurrent laryngeal nerve palsy was observed. The mean follow-up duration was 15.8＋_1.3 months （range, 12-23 months）. The mean preoperative VAS score of the upper limb was 8.5＋_0.5 points（range, 7-10 points）, while the mean VAS score at final follow-up was 1.4＋0.2 points（range, 0-3 points）, which showed significant difference（P〈0.05）. The mean preoperative NDI was 26.4＋_1.3 points（range, 22-31 points）, while the mean postoperative NDI was 4.2_＋0.6 points（range, 3-8 points）, the difference was significant（P〈0.05）, the rate of improvement was 84.1%. The mean preoperative disc height was 5.4_＋0.7ram（range, 4.2-6.1mm）, and the mean disc height at final fol- low-up was 4.9_＋0.7ram（range, 3.6-5.8mm）, which showed no difference（P〉O.05）. The postoperative satisfaction rate was 100%. Conehtsions： Transeorporeal anterior cervical mieroforaminotomy is minimal invasive to the disc, which is an effective procedure for unilateral cervical radiculopathy.