Objective To investigate the effect and safety of the anterior uncovertebral joint resection in treatment of cervical spondylotic myelopathy accompanied by radiculopathy. Methods From March 2002 toJuly 2004, 9 patients (5 males, 4 females; aged 38-66) with cervical spondylotic myelopathy accompanied by radiculopathy underwent the anterior uncovertebral joint resection and discectomy using the titanium cage implantation. There were 6 unilateral and 3 bilateral compressed nerve roots. Results During the follow-up for 3-16 months, CT scanning or X-ray films revealed thatall the patients improved with an enlargement of the intervertebral foramen, and MRI demonstrated that compression of the spinal cord and nerve roots vanished.Seven patients had a relief in the radicular pain although the other 2 still had a residual pain. All the patients improved to some extent in symptoms of myelopathy. No patient suffered vertebral artery injury during the operation. Conclusion The uncovertebral joint resection can directly decompressthe nerve roots. The key to avoidance of an injury to the vertebral artery is agood understanding of the regional anatomy and a good performance of the operation.
ObjectiveTo investigate the influence of uncovertebral joint foraminal part excision on the motion response, stability and clinical outcomes after single-level cervical disc replacement. MethodsThe 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. ResultsThere 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. ConclusionUncovertebral joint foraminal part excision can be used in single-level Prestige LP cervical disc replacement, which is safe and reliable.
ObjectiveTo measure anatomical parameters related to cervical uncovertebral joint and provide data support for the design of uncovertebral joint fusion cage.MethodsAccording to the inclusion and exclusion criteria, raw DICOM data of cervical CT scan in 60 patients (30 males and 30 females, aged 39-60 years) were obtained, then the three-dimensional cervical spine model was reconstructed for anatomical measurement by using the Mimics19.0 software. The height of the uncinate process, the length of the uncinate process, the width of the uncinate process, and the length of the uncovertebral joint in the intervertebral foramen region were measured bilaterally from C3 to C7. The anterior and posterior distances between the uncinate processes were measured from C3 to C7. The height of the uncovertebral joint space, the central height of the intervertebral disc space, and the depth of the intervertebral disc space were also measured from C2, 3 to C6, 7. The mean, standard deviation, maximum, and minimum were calculated by using the SPSS22.0 statistical software for the design of uncovertebral joint fusion cage.ResultsThe height of the uncinate process, the length of the uncinate process, the width of the uncinate process, and the length of the uncovertebral joint in the intervertebral foramen region of C3-C7 and the height of the uncovertebral joint space of C2, 3-C6, 7 showed no significant difference between two sides (P>0.05). The height of the uncovertebral joint space also had no significant difference between females and males (P>0.05). The anterior distances between the uncinate processes of C3-C7 were significantly larger than the posterior distances between the uncinate processes (P<0.05), the uncovertebral joint presented a posterior cohesive shape. The central height of the intervertebral disc space in male group was slightly higher than that in female group, and the differences were significant (P<0.05) at C2, 3 and C5, 6; the depth of the intervertebral disc space in male group was significantly higher than that in female group (P<0.05). The central height of the intervertebral disc space was (4.94±0.49) mm (range, 3.81-5.90 mm), the depth of the intervertebral disc space was (15.78±1.23) mm (range, 12.94-18.85 mm), the anterior and posterior distances between the uncinate processes were (17.19±2.39) mm (range, 13.39-24.63 mm) and (10.84±2.12) mm (range, 7.19-16.64 mm), respectively. According to the results of the anatomical research, the height of the uncovertebral joint fusion cage was designed as 5, 6, 7, and 8 mm; the depth of the uncovertebral joint fusion cage was designed as 12, 13, 14, 15, and 16 mm; the width of the uncovertebral joint fusion cage was designed as 14-18 mm; and the two wings are designed as arc-shape with 2 and 3 mm in width.ConclusionThere are certain differences in the anatomical parameters of the uncovertebral joint between different segments. The uncovertebral joint fusion cage that designed based on the results of anatomical research is suitable for most patients.