通道显微镜下颈后路椎间孔扩大成形术治疗单节段神经根型颈椎病的临床疗效

Clinical outcomes of minimally invasive posterior cervical foraminotomy for single segment cervical spondylotic radiculopathy

目的探讨通道显微镜下颈后路椎间孔扩大成形（PCF）椎间盘摘除术治疗单节段神经根型颈椎病（CSR）的临床疗效。方法回顾性分析2014年1月-2017年1月中国科学技术大学附属第一医院脊柱外科行PCF手术治疗的30例单节段神经根型颈椎病患者临床资料，分析患者围手术期指标、上肢疼痛视觉模拟评分（VAS）、颈椎功能障碍指数（NDI）、颈椎生理曲度、椎间隙高度及节段稳定性。结果30例患者平均切口长度为（2．2±0．2）cm，手术时间为（50±4．8）rain，术中出血量为（80．5±18．6）mL。所有患者获得随访，平均随访时间18．6（12～25）个月。上肢疼痛VAS术前、术后1天、术后1年分别为（7．83±2．10）、（1．80±0．41）、（1．20±0．81）分；上肢疼痛VAS术后1天及术后1年时较术前均明显改善，差异有统计学意义（P值均〈0．05）。NDI由术前的30．23±4．81降至术后1年时的2．40±0．62，差异有统计学意义（P〈0．05）。颈椎生理曲度术前12．28°±8．34°，末次随访时为14．32°±4．56°，差异无统计学意义（P〉0．05）。术前和末次随访时病变节段椎间隙高度分别为（5．62±1．28）mm、（5．34±1．13）mm，差异无统计学意义（P〉0．05）。末次随访时未见颈椎失稳患者。结论通道显微镜下颈后路椎间孔扩大成形术治疗单节段神经根型颈椎病均可获得较为满意的临床疗效，具有创伤小、恢复快等优点。

Objective To report the clinical outcomes of minimally invasive posterior cervical foraminotomy （PCF） for single segment cervical spondylotic radiculopathy（CSR）. Methods From January 2014 to January 2017, 30 consecutive patients with single segment CSR underwent posterior cervical foraminotomy in the Department of Spine Surgery of the First Affiliated Hospital of University of Science and Technology of China were respectively reviewed. We retrospectively reviewed demographic, radiologic and clinical data from the patients. The visual analogue scale （ VAS ） score and neck disability index （NDI） were used for clinical follow-up, and radiologic follow-up was performed to compare the changes of cervical sagittal alignment, segmental stability and disc-space height of treated segment. Results The mean length of skin incision was （2.2 ± 0.2） cm; the operative time was （50±4.8 ） min, and the bleeding volume was （80.5± 18.6） mL. All patients were followed-up, the average duration of follow-up was 18.6 （12-25 ） months. VAS scores for arm decreased from 7.83±2.10 preoperatively to 1.80±0.41 postoperatively and 1.20±0.81 at 1 year（all P values 〈0.05） . The NDI decreased from 30.23±4.81 preoperatively to 2.40 ± 0.62 at 1 year （P〈0.05）. Cervical curvature increased from 12.28 °± 8.34° to 14.32°± 4.56° at 1 year , which showed no significant changes （ P 〉 0.05 ）. The mean disc-space heights of treated segment were （5.62±1.28） mm preoperatively and decreased to （5.34±1.13） mm at 1 year , which showed no significant changes （ P〉0.05 ）. There was no segmental instability at 1 year. Conclusions Minimally invasive PCF can achieve satisfying clinical outcomes.