대한정형외과학회지 (Journal of the Korean Orthopaedic Association)

  • 제56권6호
  • /
  • Pages.512-518
  • /
  • 2021
  • /
  • 1226-2102(pISSN)
  • /
  • 2005-8918(eISSN)
대한정형외과학회 (Korean Orthopaedic Association)
권호 표지
DOI QR코드

DOI QR Code

전방 경유 디스크 절제술 및 유합술과 후방 추간공 절제술에서의 경추 추간공의 형태학적 변화 비교

Comparison of the Morphometric Changes in the Cervical Foramen: Anterior Cervical Discectomy and Fusion versus Posterior Foraminotomy

  • Chung, Sung-Soo (Department of Orthopedic Surgery, Busan Bumin Hospital) ;
  • Sun, Woo-Sung (Department of Neurological Surgery, Busan Bumin Hospital) ;
  • Chung, Jong-Chul (Department of Neurological Surgery, Busan Bumin Hospital) ;
  • Heo, Ki-Sung (Department of Orthopedic Surgery, Busan Bumin Hospital) ;
  • Kim, Hyun-Min (Department of Orthopedic Surgery, Busan Bumin Hospital)
  • 투고 : 2020.09.29
  • 심사 : 2020.12.13
  • 발행 : 2021.12.30
⟨ 이전 논문 다음 논문 ⟩

초록

목적: 경추 추간공 협착증에서 전방경유 경추 추간판 절제술 및 유합술과 추간공 절제술 후 추간공의 크기 변화 및 임상 결과를 비교하여 그 효용성에 대하여 알아보고자 하였다. 대상 및 방법: 2018년 1월부터 2019년 3월까지 전방경유 경추 추간판 절제술 및 유합술 및 추간공 절제술을 시행한 186명 중에서 나이, 성별, 체질량지수 등을 고려한 환자-대조군 연구를 통해 선별된 102예를 대상으로 하여 후향적으로 분석하였다. 술 전 및 술후 5일째 자기공명영상을 촬영하여 전방경유 경추 추간판 절제술 및 유합술을 시행 받은 군(A군-51명)과 추간공 절제술을 시행 받은 군(B군-51명) 사이의 추간공의 크기 변화 및 임상 결과를 비교하였다. 결과: 술 후 A군에서 추간공 수직 직경의 변화는 평균 1.7 mm, B군에서는 평균 1.2 mm로 증가하였으며 A군에서 0.5 mm 높게 나타났다(p=0.042). 추간공 횡단 직경의 변화는 A군에서 평균 1.2 mm, B군에서는 1.8 mm로 B군에서 0.6 mm 넓게 나타났다(p=0.021). Neck disability index (NDI), Japanese orthopaedic association (JOA) score 모두 양 군에서 호전되는 결과를 보였으며 A군에서 더 높은 호전을 보였지만 통계학적으로 유의하지는 않았다(각각 p=0.356, p=0.607). 결론: 미세현미경과 내시경을 이용한 추간공 절제술은 전방경유 경추 추간판 절제술 및 유합술에 필적하는 임상적 결과를 보였고, 수술 후 경부의 통증 및 불편감을 줄이면서 인접분절의 퇴행변화를 줄일 수 있기 때문에 경추의 추간공 협착증 환자에서 유용한 치료 방법 중 하나로 판단된다.

Purpose: This study compared the change in foraminal space on magnetic resonance imaging (MRI) and the clinical outcome after anterior cervical discectomy and fusion (ACDF) versus foraminotomy in cervical foraminal stenosis. Materials and Methods: A retrospective case-control study was conducted from January 2018 to March 2019 on 186 patients who underwent ACDF and foraminotomy. One hundred and two cases were selected considering age, sex, and body mass index. MRI was performed before and on the 5th day after surgery to compare the changes in the foraminal diameter between the ACDF group (group A-51) and foraminotomy group (group B-51). Results: Between groups A and B, the average change in foraminal vertical diameter was 1.7 mm and 1.2 mm, respectively; group A was 0.5 mm larger difference (p=0.042). The average change in foraminal transverse diameter was 1.2 mm and 1.8mm, respectively; group B showed a 0.6 mm larger change (p=0.21). Both the neck disability index (NDI) and Japanese orthopaedic association (JOA) scores improved in both groups. Group A showed more improvement, but there was no significant difference (p=0.356, p=0.607, respectively). Conclusion: Foraminotomy is a useful option for patients with foraminal stenosis of the cervical spine because it showed comparable clinical and morphological results to ACDF and could minimize motion segment loss and muscle and ligament damage.

키워드

참고문헌

  1. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958;40-A:607-24. https://doi.org/10.2106/00004623-195840030-00009
  2. DePalma AF, Rothman RH, Lewinnek GE, Canale ST. Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet. 1972;134:755-8.
  3. Hilibrand AS, Yoo JU, Carlson GD, Bohlman HH. The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine (Phila Pa 1976). 1997;22:1574-9. https://doi.org/10.1097/00007632-199707150-00009
  4. Kwon YJ. Early surgical results of minimally invasive posterior foraminotomy using tubular retractor for cervical radiculopathy. J Korean Soc Spine Surg. 2007;14:67-72. https://doi.org/10.4184/jkss.2007.14.2.67
  5. Wagner R, Telfeian AE, Iprenburg M, Krzok G. Minimally invasive fully endoscopic two-level posterior cervical foraminotomy: technical note. J Spine Surg. 2017;3:238-42. https://doi.org/10.21037/jss.2017.05.06
  6. Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg. 2001;95(1 Suppl):51-7. https://doi.org/10.3171/jns.2001.95.1.0051
  7. Nguyen J, Chu B, Kuo CC, Leasure JM, Ames C, Kondrashov D. Changes in foraminal area with anterior decompression versus keyhole foraminotomy in the cervical spine: a biomechanical investigation. J Neurosurg Spine. 2017;27:620-6. https://doi.org/10.3171/2017.2.SPINE141237
  8. You JW, Sohn HM, Lee JY, Lee CG. The correlation between radiographic and clinical results after anterior cervical discectomy and fusion. J Korean Soc Spine Surg. 2006;13:81-6. https://doi.org/10.4184/jkss.2006.13.2.81
  9. Lee YS, Song WS, Choi JC, et al. The changes in neural foramen shown on computed tomography depending on the changes in the height of intervertebral disc after anterior cervical discectomy and fusion (ACDF). J Korean Soc Spine Surg. 2011;18:96-102. https://doi.org/10.4184/jkss.2011.18.3.102
  10. Yusof MI, Hassan MN, Abdullah MS. The relationship amongst intervertebral disc vertical diameter, lateral foramen diameter and nerve root impingement in lumbar vertebra. Malays Orthop J. 2018;12:21-5. https://doi.org/10.5704/MOJ.1803.004
  11. Miller LE, Block JE. Safety and effectiveness of bone allografts in anterior cervical discectomy and fusion surgery. Spine (Phila Pa 1976). 2011;36:2045-50. https://doi.org/10.1097/BRS.0b013e3181ff37eb
  12. Williams RW. Microcervical foraminotomy. A surgical alternative for intractable radicular pain. Spine (Phila Pa 1976). 1983;8:708-16. https://doi.org/10.1097/00007632-198310000-00005
  13. Jeon CH, Kim YC, Chang HG, Kim YW, Jung NS, Shin DS. The comparison of changes in the dimensions of the intervertebral disc and neural foramen between anterior lumbar interbody fusion and posterolateral fusion in the lumbar spine. J Korean Soc Spine Surg. 2007;14:263-9. https://doi.org/10.4184/jkss.2007.14.4.263
  14. Japanese Orthopaedic Association score for cervical spondylotic myelopathy. J Jpn Orthop Assoc. 1975;99: prefatory note.
  15. Vernon H, Mior S. The Neck Disability Index: a study of reliability and validity. J Manipulative Physiol Ther. 1991;14:409-15.
  16. Garvey TA, Transfeldt EE, Malcolm JR, Kos P. Outcome of anterior cervical discectomy and fusion as perceived by patients treated for dominant axial-mechanical cervical spine pain. Spine (Phila Pa 1976). 2002;27:1887-95; discussion 1895. https://doi.org/10.1097/00007632-200209010-00015
  17. Bohlman HH, Emery SE, Goodfellow DB, Jones PK. Robinson anterior cervical discectomy and arthrodesis for cervical radiculopathy. Long-term follow-up of one hundred and twenty-two patients. J Bone Joint Surg Am. 1993;75:1298-307. https://doi.org/10.2106/00004623-199309000-00005
  18. Raynor RB. Anterior or posterior approach to the cervical spine: an anatomical and radiographic evaluation and comparison. Neurosurgery. 1983;12:7-13. https://doi.org/10.1227/00006123-198301000-00002
  19. Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg. 1985;63:278-82. https://doi.org/10.3171/jns.1985.63.2.0278