| Section ?.Analysis of short-term outcomes of uncinate process resection in ACDFObjective:To compare the initial clinical efficacy of complete removal of uncinate process and reservation of uncinate process in the treatment of cervical spondylotic radiculopathy in Anterior Cervical Discectomy and Fusion(ACDF).Methods:Patients who were diagnosed as"cervical radiculopathy"treated with ACDF in our department from September 2016 to January 2018 were retrospectively reviewed.The patients were divided into the uncinate process resection group(group A:64cases)and the uncinated process reservation group(group B:141 cases)according to whether or not the uncinate process resection was performed.The Japanese orthopedic association(JOA)score,neurological improvement rate(recovery rate,RR)and visual analogue scale(VAS)were used to evaluate the postoperative clinical outcomes of the two groups postoperative 2nd day,2 months,6 months,1 year,etc.Lateral and oblique45-degree X-rays,and C2-7 COBB angle was measured before and after surgery.At 6months after surgery,the decompression was confirmed by re-examining cervical magnetic resonance imaging(MRI).At 12 months after surgery,the fusion of the surgical segments was confirmed by extension and flexion X-ray of the cervical spine.Results:The follow-up period was 12-27 months and the mean follow-up time was18.4 months.The JOA,VAS score and C2-7COBB angle of the two groups were significantly improved after operation(P<0.05).A total of 94 patients were matched by a1:1 propensity score matching,with 47 in each group.There were no significant differences in gender,age,and BMI(P>0.05).By comparing the improvement rate of postoperative neurological function and the degree of pain relief in the two groups,the improvement rate of VAS score was 85.72±8.13%in group A and 70.50±9.63%in group B on the second day after operation.The improvement of VAS score in group A was more significant(P<0.05).However,at 1 year postoperatively,the improvement rate of VAS scores in two groups was 91.69±5.32%and 88.74±6.11%,respectively,and there was no statistical difference(P>0.05).The neurological function of the patients was significantly improved,and there was no statistical difference between the two groups(P>0.05).At 12months after operation,the cervical spine dynamic position X-ray showed that there was no significant difference in the fusion rate between two groups(c~2=0.000,P>0.05).No significant displacement of the prosthesis and internal fixation material was observed in non-fusion patients,and no revision surgery was performed in any of the cases.All patients had no serious complications such as cerebrospinal fluid leakage and vascular injury after operation.Conclusion:The patient can obtain the relief of neck pain more quickly after uncinate process resection.And single-segment uncinate resection does not reduce the fusion rate of ACDF.Section ?.Indication of uncinate process resection in ACDF procedure-------Effect of preoperative intervertebral foramen size on clinical outcomes of ACDF in treating cervical spondylotic radiculopathyObjective:To analyze the effect of preoperative cervical intervertebral foramen size on the clinical effect of Anterior Cervical Discectomy and Fusion(ACDF)in the treatment of cervical spondylotic radiculopathy,and to explore the surgical indication of complete uncinate process resection.Methods:A retrospective analysis of 181 patients who were diagnosed as"cervical radiculopathy"treated with ACDF in our department from September 2016 to January2018.The size of the cervical intervertebral foramen was evaluated by the diameter and longitudinal diameter of the intervertebral foramen,and the width and height of the intervertebral foramen before and after operation were measured by cervical oblique 45degree X-rays.Japanese orthopedic association(JOA)score,JOA recovery rate(RR),visual analogue scale(VAS)and pain relief rate(VAS recovery rate)were used to evaluate clinical outcomes after surgery.Logistic regression was used to analyze the relationship between preoperative intervertebral foramen width and height,duration of symptoms,change of C2-C7 COBB angle,postoperative intervertebral space height and postoperative pain relief.Patients were further divided according to the width of the intervertebral foramen before surgery,and the effect of different intervertebral foramen width on the improvement of postoperative VAS recovery rate was compared.Results:The follow-up period was 12-27 months and the mean follow-up time was17.5 months.There were no significant differences in age,gender,and BMI between follow-up patients.Logistic regression analysis showed that the preoperative intervertebral foramen width was less than 3 mm,which was a risk factor that affected the postoperative pain relief.Therefore,patients were grouped according to whether the preoperative intervertebral foramen width was greater than 3 mm and the sample baseline was equalized by a propensity score.By comparison,the width of the intervertebral foramen after ACDF was significantly increased to(5.36±1.18)mm in patients with preoperative intervertebral foramen width?3 mm;and the improvement rate of postoperative VAS score was90.32±5.52%.In patients with preoperative intervertebral foramina<3 mm,the width of the intervertebral foramen was not significantly enlarged after ACDF,and the improvement rate of postoperative VAS score was 48.4±7.13%.There was significant difference between the two groups(P<0.05)Conclusion:When the width of the intervertebral foramen is?3mm,significant pain relief can be obtained by reconstruction of cervical lordosis and distraction of the intervertebral space.At this time,it is not necessary to perform complete resection of the uncinate process in ACDF.When the width of the intervertebral foramen is less than 3 mm,it is hardly to obtain satisfactory intervertebral foramen width expansion by ACDF.At this point,complete removal of the uncinate process during the operation should be considered.Section ?.Mechanism research and treatment strategy of neck pain with degeneration of uncovertebral jointObjective:To investigate the relationship between the uncovertebral joint(UJ)degeneration and neck pain by immunohistology of the uncinate specimens taken during the surgery.Methods:Immunohistology was performed on 5 cases of uncinate process specimens with anterior cervical discectomy and fusion using ultrasonic scalpel in our department for"cervical radiculopathy"(experimental group).And compared with 5 patients with no evidence of uncinate process degeneration in radiographic examination(control group).The pathological changes of the uncinate process after degeneration of the uncovertebral joint werestudiedbyimmunohistochemistry.Andthrough thepathological immunohistology to explore the potential relationship between uncinate process degeneration and neck pain.Results:Aggrecan was not found in the two groups by immunohistochemical study,indicating that the specimen was pure bone tissue that did not contain cartilage tissue.At the same time,in the observation of the experimental group,the secretion of sclerostin(SOST)and osteocalcin(OSTN)were significantly higher than that of the control group.It indicated that the degeneration caused the osteogenesis of the uncinate process bone to increase significantly.In addition,the secretion of substance P(substance-P,SP),calcitonin gene related peptide(CGRP)and inflammatory factor interleukin-6(IL-6)in the experimental group were also significantly higher.In the control group.Conclusion:The immunohistochemical study of the uncinate process has confirmed that the epiphysis contains substance P,CGRP and inflammatory factor IL-6,which indicates that the uncinate process itself may be one of the potential factors leading to neck pain. |
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