Application of Uncovertebral Joint Foraminal Part Excision in Single-level Cervical Disc Replacement_West China Medical Journal

Authors：

 YangYunbei ¹ , DuanYuchen ¹ ,  LiuHao ¹ , HongYing ² , GongQuan ¹ , SongYueming ¹

1. Department of Orthopaedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. Operating Room, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

LiuHao, Email: liuhao6304@126.com

Keywords：

Cervical spondylotic radiculopathy; Prestige LP cervical disc replacement; Uncovertebral joint foraminal part excision

DOI：

10.7507/1002-0179.201600543

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Objective To investigate the influence of uncovertebral joint foraminal part excision on the motion response, stability and clinical outcomes after single-level cervical disc replacement. Methods The clinical data of 57 patients with cervical spondylotic radiculopathy, who underwent single-level Prestige LP cervical disc replacement in West China Hospital of Sichuan University from January 2012 to January 2015, were retrospectively analyzed.According to whether to have the uncovertebral joint foraminal part excision in the process of operation, two groups were divided, named excision group and non-excision group.The Japanese Orthopedic Association score (JOA), neck disability index (NDI) and visual analogue score (VAS) were used to evaluate the clinical outcomes pre-and post-operatively.The stability, overall cervical alignment, range of motion of treated levels in flexion-extension and lateral bending, and the transverse and longitudinal diameter of intervertebral foramen were measured by X-ray and CT-3D examination.The complications and reoperations were also recorded. Results There were statistically significant improvement in the JOA, NDI, neck VAS and arm VAS scores in both of the two groups after the surgery (P < 0.05).The improvement of the NDI and the arm VAS scores were more obvious after the surgery in excision group.The overall cervical alignment, the range of motion of treated levels in flexion-extension and lateral bending were well maintained post-operatively (P > 0.05), and the differences between the two groups were not significant (P > 0.05).The transverse diameter of intervertebral foramen was significantly increased in excision group post-operatively (P < 0.05) while the longitudinal diameter was not (P > 0.05);both of the transverse and longitudinal diameter of intervertebral foramen didn't differ much post-operatively in the non-excision group (P > 0.05).All the prostheses showed a good stability.No prostheses shift, dislocation or unfixed prostheses were found. Conclusion Uncovertebral joint foraminal part excision can be used in single-level Prestige LP cervical disc replacement, which is safe and reliable.

Citation： YangYunbei, DuanYuchen, LiuHao, HongYing, GongQuan, SongYueming. Application of Uncovertebral Joint Foraminal Part Excision in Single-level Cervical Disc Replacement. West China Medical Journal, 2016, 31(12): 1975-1980. doi: 10.7507/1002-0179.201600543 Copy

1.	Schneeberger AG, Boos N, Schwarzenbach O, et al. Anterior cervical interbody fusion with plate fixation for chronic spondylotic radiculopathy:a 2-to 8-year follow-up[J]. J Spinal Disord, 1999, 12(3):215-220.
2.	Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion:clinical and radiographic results of a randomized, controlled, clinical trial[J]. Spine (Phila Pa 1976), 2009, 34(2):101-107.
3.	Emery SE, Bohlman HH, Bolesta MJ, et al. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up[J]. J Bone Joint Surg, 1998, 80(7):941-951.
4.	Sugawara T, Itoh Y, Hirano Y, et al. Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages[J]. Acta Neurochir (Wien), 2009, 151(4):303-309.
5.	Traynelis VC, Treharne RW. Use of prestige (R) LP artificial cervical disc in the spine[J]. Expert Rev Med Devices, 2007, 4(4):437-440.
6.	Mummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion:a randomized controlled clinical trial[J]. J Neurosurg Spine, 2007, 6(3):198-209.
7.	Reitman CA, Hipp JA, Nguyen L, et al. Changes in segmental intervertebral motion adjacent to cervical arthrodesis:a prospective study[J]. Spine (Phila Pa 1976), 2004, 29(11):E221-E226.
8.	袁健东, 陈鑫, 刘彩龙, 等.颈前路术中钩椎关节切除减压治疗神经根型颈椎病的疗效分析[J].中国骨伤, 2012, 25(9):721-725.
9.	Snyder JT, Tzermiadianos MN, Ghanayem AJ, et al. Effect of uncovertebral joint excision on the motion response of the cervical spine after total disc replacement[J]. Spine (Phila Pa 1976), 2007, 32(26):2965-2969.
10.	Smith GW, Robinson RA. The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion[J]. J Bone Joint Surg, 1958, 40-A (3):607-624.
11.	Lim MR, Girardi FP, Zhang K, et al. Measurement of total disc replacement radiographic range of motion:a comparison of two techniques[J]. J Spinal Disord Tech, 2005, 18(3):252-256.
12.	贾连顺.颈椎病研究的现状进展和展望[J].中国矫形外科杂志, 2001, 8(8):733-734.
13.	Gornet MF, Burkus JK, Shaffrey ME, et al. Cervical disc arthroplasty with PRESTIGE LP disc versus anterior cervical discectomy and fusion:a prospective, multicenter investigational device exemption study[J]. J Neurosurg Spine, 2015, 23(5):558-573.
14.	Chen F, Yang J, Ni B, et al. Clinical and radiological follow-up of single-level Prestige LP cervical disc replacement[J]. Arch Orthop Traum Surg, 2013, 133(4):473-480.
15.	Bono CM, Ghiselli G, Gilbert TJ, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders[J]. Spine J, 2011, 11(1):64-72.
16.	Peng CW, Yue WM, Basit A, et al. Intermediate results of the prestige LP cervical disc replacement clinical and radiological analysis with minimum two-year follow-up[J]. Spine (Phila Pa 1976), 2011, 36(2):E105-E111.
17.	Hartman J. Anatomy and clinical significance of the uncinate process and uncovertebral joint:a comprehensive review[J]. Clinical Anatomy, 2014, 27(3, SI):431-440.
18.	Kotani Y, Mcnulty PS, Abumi K, et al. The role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine:a biomechanical study[J]. Spine (Phila Pa 1976), 1998, 23(14):1559-1565.
19.	成俊, 刘浩, 林旭, 等.前路钩椎关节切除在颈椎病治疗中的初步应用[J].中国修复重建外科杂志, 2006, 20(4):380-382.
20.	Kowalczyk I, Lazaro BC, Fink M, et al. Analysis of in vivo kinematics of 3 different cervical devices:Bryan disc, ProDisc-C, and Prestige LP disc[J]. J Neurosurg Spine, 2011, 15(6):630-635.

1. Schneeberger AG, Boos N, Schwarzenbach O, et al. Anterior cervical interbody fusion with plate fixation for chronic spondylotic radiculopathy:a 2-to 8-year follow-up[J]. J Spinal Disord, 1999, 12(3):215-220.
2. Heller JG, Sasso RC, Papadopoulos SM, et al. Comparison of BRYAN cervical disc arthroplasty with anterior cervical decompression and fusion:clinical and radiographic results of a randomized, controlled, clinical trial[J]. Spine (Phila Pa 1976), 2009, 34(2):101-107.
3. Emery SE, Bohlman HH, Bolesta MJ, et al. Anterior cervical decompression and arthrodesis for the treatment of cervical spondylotic myelopathy. Two to seventeen-year follow-up[J]. J Bone Joint Surg, 1998, 80(7):941-951.
4. Sugawara T, Itoh Y, Hirano Y, et al. Long term outcome and adjacent disc degeneration after anterior cervical discectomy and fusion with titanium cylindrical cages[J]. Acta Neurochir (Wien), 2009, 151(4):303-309.
5. Traynelis VC, Treharne RW. Use of prestige (R) LP artificial cervical disc in the spine[J]. Expert Rev Med Devices, 2007, 4(4):437-440.
6. Mummaneni PV, Burkus JK, Haid RW, et al. Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion:a randomized controlled clinical trial[J]. J Neurosurg Spine, 2007, 6(3):198-209.
7. Reitman CA, Hipp JA, Nguyen L, et al. Changes in segmental intervertebral motion adjacent to cervical arthrodesis:a prospective study[J]. Spine (Phila Pa 1976), 2004, 29(11):E221-E226.
8. 袁健东, 陈鑫, 刘彩龙, 等.颈前路术中钩椎关节切除减压治疗神经根型颈椎病的疗效分析[J].中国骨伤, 2012, 25(9):721-725.
9. Snyder JT, Tzermiadianos MN, Ghanayem AJ, et al. Effect of uncovertebral joint excision on the motion response of the cervical spine after total disc replacement[J]. Spine (Phila Pa 1976), 2007, 32(26):2965-2969.
10. Smith GW, Robinson RA. The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion[J]. J Bone Joint Surg, 1958, 40-A (3):607-624.
11. Lim MR, Girardi FP, Zhang K, et al. Measurement of total disc replacement radiographic range of motion:a comparison of two techniques[J]. J Spinal Disord Tech, 2005, 18(3):252-256.
12. 贾连顺.颈椎病研究的现状进展和展望[J].中国矫形外科杂志, 2001, 8(8):733-734.
13. Gornet MF, Burkus JK, Shaffrey ME, et al. Cervical disc arthroplasty with PRESTIGE LP disc versus anterior cervical discectomy and fusion:a prospective, multicenter investigational device exemption study[J]. J Neurosurg Spine, 2015, 23(5):558-573.
14. Chen F, Yang J, Ni B, et al. Clinical and radiological follow-up of single-level Prestige LP cervical disc replacement[J]. Arch Orthop Traum Surg, 2013, 133(4):473-480.
15. Bono CM, Ghiselli G, Gilbert TJ, et al. An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders[J]. Spine J, 2011, 11(1):64-72.
16. Peng CW, Yue WM, Basit A, et al. Intermediate results of the prestige LP cervical disc replacement clinical and radiological analysis with minimum two-year follow-up[J]. Spine (Phila Pa 1976), 2011, 36(2):E105-E111.
17. Hartman J. Anatomy and clinical significance of the uncinate process and uncovertebral joint:a comprehensive review[J]. Clinical Anatomy, 2014, 27(3, SI):431-440.
18. Kotani Y, Mcnulty PS, Abumi K, et al. The role of anteromedial foraminotomy and the uncovertebral joints in the stability of the cervical spine:a biomechanical study[J]. Spine (Phila Pa 1976), 1998, 23(14):1559-1565.
19. 成俊, 刘浩, 林旭, 等.前路钩椎关节切除在颈椎病治疗中的初步应用[J].中国修复重建外科杂志, 2006, 20(4):380-382.
20. Kowalczyk I, Lazaro BC, Fink M, et al. Analysis of in vivo kinematics of 3 different cervical devices:Bryan disc, ProDisc-C, and Prestige LP disc[J]. J Neurosurg Spine, 2011, 15(6):630-635.

West China Medical Journal

Application of Uncovertebral Joint Foraminal Part Excision in Single-level Cervical Disc Replacement

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