전방 경추 미세 추간공 확대술의 장기 추적 결과|RISS 상세보기

다국어 초록 (Multilingual Abstract)

Objective: We previously reported excellent early and midterm clinical results of anterior cervical microforaminotomy (ACMF) for patients with cervical radiculopathy caused by disc herniation or foraminal stenosis. ACMF is accepted as a minimally invasive functional spinal surgery, but its long-term outcomes are unknown. The purpose of this study is to evaluate the long-term clinical and radiographic results of ACMF.
Methods: We performed a questionnaire survey and retrospective analysis of 13 patients with cervical radiculopathy who underwent ACMF from 1998 to 2002. Clinical and radiographic data from these 13 patients(one-level operations in seven patients, and two-level operations in six patients) were analysed. We measured disc height, sagittal plane displacement and sagittal plane angulation to evaluate instability.
Results: Thirteen patients answered the questionnaires. Mean follow-up was 77.3 months(ranged from 498 to 110 months). The surgical outcome was excellent in three patients(23%) and good in nine patients(69%). One patient had only a fair outcome, but there were no cases of recurrence, reoperation or additional surgery.Twelve of 13 patients were satisfied with the results of their surgery. On the average, the loss of disc height was 0.84mm(16.6% of preoperative disc height), increase of displacement was 0.47mm and increase of sagittal plane angulation was 0.65°. All patients maintained stability during the follow-up period. Although the patient sample included in this study is a different sample from that surveyed in our previous study of mid-term results, the long-term radiographic outcomes showed that the parameters of instability tended to decrease in comparison to those midterm results. Three-dimensional computed tomography scans showed signs indicative of bone remodeling, including regrowth of the resected bone and gradual fusion around the uncovertebral joint (UVJ) where ACMF was performed. In spite of bone regeneration around the UVJ, the neural foramen appeared to be well maintained in all patients.
Conclusion: In the long-term, ACMF is clinically effective method for the treatment of cervical radiculopathy, although disc height was decreased and sagittal angulation was increased. UVJ with mild hypermobility that was apparent at midterm appears to be restored during long-term follow-up. The efficacy of this procedure should be evaluated in additional studies involving large patient series.

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참고문헌 (Reference)

1 김영규, "전방 경추 미세 추간공 확대술의 중기 추적 결과" 대한신경외과학회 35 (35): 250-255, 2004

2 Espersen JC., "Treatment of cervical disc disease using Cloward's technique, I. General results, effect of different operative methods and complication in 1106 patients" 70 : 97-114, 1984

3 Hakuba A., "Trans-unco-discal approach. a combined anterior and lateral approach to cervical discs" 45 : 284-291, 1976

4 Smith GW., "The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc interbody fusion" 40 : 607-624, 1958

5 Kotani Y., "The role of Anteromedial foraminotomy and the uncovertebral joint in the stability of the cervical spine" 23 : 1559-1565, 1998

6 Cloward RB., "The anterior approach for removal of ruptured cervical disks" 15 : 602-617, 1958

7 Arnasson O., "Surgical and conservative treatment of cervical spondylotic radiculopathy and myelopathy" 84 : 48-53, 1987

8 Wada E., "Subtotal corpectomy versus laminoplasty for multilevel cervical spondylotic myelopathy: a long-term follow-up study over 10 years" 26 : 1443-1447, 2001

9 Bailey RW., "Stabilization of the cervical spine by anterior fusion" 42 : 565-594, 1960

10 Jho HD., "Spinal cord decompression via microsurgical anterior foraminotomy for spondylotic cervical myelopathy" 40 : 124-129, 1997