Spinal Surgery 原著 Original Article 1, Abstract Background The ideal surgical approach for cervical radiculopathy
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1 Spinal Surgery 原著 Original Article, 3 4 Abstract Background The ideal surgical approach for cervical radiculopathy remains elusive. Posterior endoscopic cervical foraminotomy PECF is minimally invasive. This technique can preserve cervical range of motion and reduce adjacent segment degeneration. We report the results for cervical radiculopathy treated with PECF. Methods PECF was performed on 5 patients men and 3 women mean age, 5.8 years range, 4 65 years. Affected cervical levels included C5 6 patients, C6 7 patients, and C7 T patient. Patients had cervical radiculopathy due to single level, unilateral foraminal stenosis or soft disc herniation. Clinical status was evaluated preoperatively and month postoperatively using the neck disability index NDI, the Japan Orthopaedic Association JOA score, and the numerical rating scale NRS for neck and arm pain. Results The NDI was improved after surgery. The mean JOA score recovery rate was Complete relief of radiculopathic neck pain NRS and complete or partial improvement in arm pain NRS were observed in these patients. Conclusion Advantages of PECF for treatment of cervical radiculopathy included a small skin incision and minimum facet joint resection when decompressing the cervical nerves. We advocate PECF as an alternative surgical intervention for cervical radiculopathy. Appropriate surgical indications and meticulous endoscopic technique are mandatory to achieve satisfactory outcomes. Received March 4, 7 accepted July 8, 7 Key words cervical radiculopathy, Japan Orthopaedic Association score, neck disability index, numerical rating scale, posterior endoscopic cervical foraminotomy Department of Spine, Spinal Cord, Peripheral Nerve Surgery, Shin yurigaoka General Hospital Address reprint requests to Yukoh Ohara, M.D., Department of Spine, Spinal Cord, Peripheral Nerve Surgery, Shin yurigaoka General Hospital, 55 Furusawa, Asao ku, Kawasaki shi, Kanagawa 5 6, Japan Department of Neurosurgery, Sendai Medical Center 3 Department of Neurosurgery, Kohnan Hospital 4 Department of Neurosurgery, Tohoku University Graduate School of Medicine VOL. 3 NO
2 quality of life anterior cervical discectomy with fusion ACDF anterior foraminotomy 3,4 percutaneous endoscopic cervical foraminotomy PECF 5,6 PECF percutaneous endoscopy PE 7.5 mm PECF PECF 6 7 PECF 5 neck disability index NDI Japan Orthopaedic Association score JOA score JOA score JOA score 7 JOA score numerical rating scale NRS percutaneous endoscopic cervical discectomy PECD C5 6 C6 7 C7 T ml ml NDI JOA score NRS NRS NRS MRI T thin slice MRI fast imaging employing steady state acquisition FIESTA C5 6 C6 PECF 8 ml X X point 6 C6 C5 7.5 mm X point C5 6 obturator X system straight cannula 8 mm 5 working length 65 mm working channel 4. mm Richard Wolf Surgical Instrument Co. C cmh O PE 3.5 mm high speed diamond drill Nakanishi Co. 3 egg shell C6 PE bipolar coagulator Elliquence Co. 84 VOL. 3 NO. 3 7
3 Table Patient characteristic Case Age Sex Diagnosis Side Level Surgery time min Intraoperative bleeding ml Length of hospital stay days Follow up period days Woman Man Woman Right C6/7 C7/Th C6/ Man C5/ Woman CDH CDH Foraminal stenosis Foraminal stenosis CDH C5/6 8 CDH cervical disc herniation Table Case Presenting symptoms Neck NRS Preoperative Postoperative Preoperative Postoperative Recovery rate for NDI NDI JOA score JOA score JOA score Preoperative Postoperative Arm NRS Preoperative Postoperative JOA Japan Orthopaedic Association, NDI neck disability index, NRS numerical rating scale recovery rate for JOA score postoperative JOA score preoperative JOA score / 7 preoperative JOA score a d c b e f Fig. Preoperative conventional axial T weighted magnetic resonance imaging a, b did not show any lesions. However, fast imaging employing steady state acquisition c revealed left C5/6 disc herniation causing foraminal stenosis arrow. The nuchal skin incision measured 7.5 mm d. Preoperative e and postoperative f computed tomography scans at C5/6 level. 脊髄外科 VOL. 3 NO. 3 7 年 月 85
4 a b c d e f An oblique working channel 8. mm outer diameter was introduced on the obturator, which was placed at the X point under fluoroscopic guidance. Boundaries of the inferior and superior lamina and medial margin of the facet joint were identified. After soft tissue dissection around the X point, bone was removed using a high speed drill,. Complete decompression of the cervical nerve root was achieved by removing the lamina with a small curetteand Kerrison rongeur. Finally, a tunnel approximately mm wide was created, and the nerve root was fully exposed towards its dural origin. CT C5 6 level NRS PECF PECF 7.5 mm surgical site infection SSI 5 SSI 3 PECF 7 6 PECF 5 working space 6 disorientation X point PECF PELD 5 learning curve PELD 86 VOL. 3 NO. 3 7
5 PECF PELD PECF PECF PECF Visual analogue Scale 5 83 Macnab C5 5 6 PECF 4 ml.5 PECF allodynia 6 Kim 8 posterior percutaneous endoscopic cervical diskectomy PECD 3 cervical sagittal aligment Macnab Ruetten 9 PECF perineural membrane 3 ACDF Smith Robinson Williams Isu corpectomy anterior foraminotomy, ACDF anterior foraminotomy gold standard ACDF anterior foraminotomy PECF single port PECD 6 PECD 7 PECD 8 9 Jagannathan 6 5 PECF VOL. 3 NO
6 PECF 4 limitation 5 PECF PECF 3 PECF gold standard PECF PECF PED COI COI The authors would like to thank Maxwell Cheong, B. Eng. for the English language review. 文献 Olivero WC, Dulebohn SC Results of halter cervical traction for the treatment of cervical radiculopathy retrospective review of 8 patients. Neurosurg Focus ECP, Sampath P, Bendebba M, Davis JD, et al Outcome in patients with cervical radiculopathy. Prospective, multicenter study with independent clinical review. Spine , Lubelski D, Healy AT, Silverstein MP, et al Reoperation rates after anterior cervical discectomy and fusion versus posterior cervical foraminotomy a propensity matched analysis. Spine J 77 83, 5 4 Liu WJ, Hu L, Chou PH, et al Comparison of anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of cervical radiculopathy a systematic review. Orthop Surg45 43, Zhang JM, An J Cytokines, inflammation, and pain. Int Anesthesiol Clin 7 37, 7 8 Kim CH, Shin KH, Chung CK, et al Changes in cervical sagittal alignment after single level posterior percutaneous endoscopic cervical diskectomy. Global Spine J3 38, 5 9 Ruetten S, Komp M, Merk H, et al Full endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9 mm endoscopes a prospective, randomized, controlled study. Spine , Shao MM, Chen CH, Lin ZK, et al Comparison of the more than 5 year clinical outcomes of cervical disc arthroplasty versus anterior cervical discectomy and fusion A protocol for a systematic review and meta analysis of prospective randomized controlled trials. Medicine e5733, 6 3 Jho HD Microsurgical anterior cervical foraminotomy for radiculopathy a new approach to cervical disc herniation. J Neurosurg 55 6, Umebayashi D, Hara M, Nakajima Y, et al Transvertebral anterior cervical foraminotomy midterm outcomes of clinical and radiological assessments including the finite element method. Eur Spine J , 3 5 Jho HD Failed anterior cervical foraminotomy. J Neurosurg Suppl 5, Tzaan WC Anterior percutaneous endoscopic cervical discectomy for cervical intervertebral disc herniation outcome, complications, and technique. J Spinal Disord Tech 4 43, 8 Tumialán LM, Ponton RP, Gluf WM Management of unilateral cervical radiculopathy in the military the cost effectiveness of posterior cervical foraminotomy compared with anterior cervical discectomy and fusion. Neurosurg Focus E7, 9 Fehlings MG, Gray RJ Posterior cervical foraminotomy for the treatment of cervical radiculopathy. J Neurosurg Spine , 9 Jagannathan J, Sherman JH, Szabo T, et al The posterior cervical foraminotomy in the treatment of cervical disc osteophyte disease a single surgeon experience with a minimum of 5 years clinical and radiographic follow up. J Neurosurg Spine , 9 Zdeblick TA, Zou D, Warden KE, et al Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg Am 7, VOL. 3 NO. 3 7
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