J Korean Neurosurg Soc.  2021 Jul;64(4):552-561. 10.3340/jkns.2020.0263.

Comparison between Anterior Cervical Decompression with Fusion and Posterior Cervical Fusion with Wide Facetectomy for Treatment of Severe Bony Foraminal Stenosis

• Lee S
• Cho DC
• Chon H
• Roh SW
• Choi I
• Park JH

• KMID: 2517688
• DOI: http://doi.org/10.3340/jkns.2020.0263

Abstract

Objective
: To compare the anterior cervical discectomy and fusion (ACDF) and posterior cervical fusion (PCF) with wide facetectomy in the treatment of parallel-shaped bony foraminal stenosis (FS).
Methods
: Thirty-six patients underwent surgery due to one-or-two levels of parallel-shaped cervical FS. ACDF was performed in 16 patients, and PCF using CPS was performed in 20 patients. All patients were followed up at 1, 3, 6, and 12 months postoperatively. Standardized outcome measures such as Numeric rating scale (NRS) score for arm/neck pain and Neck disability index (NDI) were evaluated. Cervical radiographs were used to compare the C2–7 Cobb’s angle, segmental angle, and fusion rates.
Results
: There was an improvement in NRS scores after both approaches for radicular arm pain (mean change -6.78 vs. -8.14, p=0.012), neck pain (mean change -1.67 vs. -4.36, p=0.038), and NDI score (-19.69 vs. -18.15, p=0.794). The segmental angle improvement was greater in the ACDF group than in the posterior group (9.4°±2.7° vs. 3.3°±5.1°, p=0.004). However, there was no significant difference in C2–7 Cobb angle between groups (16.2°±7.9° vs. 14.8°±8.5°, p=0.142). As a complication, dysphagia was observed in one case of the ACDF group.
Conclusion
: In the treatment of parallel-shaped bony FS up to two surgical levels, segmental angle improvement was more favorable in patients who underwent ACDF. However, PCF with wide facetectomy using CPS should be considered as an alternative treatment option in cases where the anterior approach is burdensome.

Keyword

Cervical radiculopathy; Cervical spine; Facet joint; Foraminotomy; Spinal fusion

Figure

• 

  Fig. 1. The shape of narrowed foramen on axial computed tomography scans. A : Parallel-shaped foraminal stenosis (FS) on the intervertebral level. The entire path of foramen was narrowed from the entrance zone to the exit zone. B : In contrast to parallel-shaped FS, V-shaped FS becomes wider at the exit zone.

• 

  Fig. 2. A 70-year-old man with tingling in both arms and left elbow flexion weakness. Severe parallel shape foraminal stenosis (FS) was seen on preoperative computed tomography (cT) imaging, with the left FS being more pronounced. A : Preoperative sagittal cT image show the c5–6, c6–7 foramen. B : Preoperative axial cT image of the c5–6 level foramen. c : Sagittal cT image of 12 months after c5–6 and c6–7 wide facetectomy (Ponte osteotomy) with fusion. cervical pedical screws were inserted into both sides of c6 and c7, and lateral mass screws were inserted into both sides of the c5. d : Axial cT image of the c5–6 level 12 months after surgery. Both sides of the c6 superior articular processes were removed, and the entire path of c5–6 foramen was widened.

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  Fig. 3. A lateral cervical X-ray of a patient in a neutral position shows the c2–7 cobb angle measurement between the lower border of the c2 body and the lower border of the c7 body. The segmental angle measurement is made between the lower border of the distal instrumented vertebral body and the upper border of the proximal instrumented vertebral body. A : Preoperative image. B : Immediate postoperative image. The segmental angle of surgical index level increased after anterior cervical decompression, c5–6–7. c : X-ray image of 12 months after surgery. The segmental angle and c2–7 cobb angle remained well after 12 months.

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  Fig. 4. An illustration showing an exposed screw tip or thread of a lateral mass screw during resection of the superior and inferior articular process. In cases of wide facetectomy (red dashed line), the lateral mass screw is partially exposed, but the trajectory of the cervical pedicle screw is not affected by it.

Reference

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