The causes analysis and decompression mode choice for the cervical spondylotic radiculopathy with nerve root compression in foramen

English Keywords:Cervical spondylotic radiculopathy  Intervertebral foramen  Anterior decompression

English Abstract:

  【Abstract】 Objectives: To analyze the reasons of nerve root compression in foramen in patients with cervical spondylotic radiculopathy, and to provide rational methods for decompression. Methods: From January 2010 to August 2013, 178 patients with cervical spondylotic radiculopathy were admitted in our hospital, and 56 of them had unilateral cervical spondylotic radiculopathy with nerve root compression in foramen. Preoperative VAS was 7-10(average, 8.99±1.01) and NDI was 37-49(average, 41.15±7.12). According to preoperative radiological data, the patients were divided into three groups based on the reasons of nerve root compression in foramen: simple disc compression, 14 cases(group A); simple bony compression, 22 cases(group B); mixed compression, 20 cases(group C). In group A, cervical discs plus uncovertebral joints were removed, and the affected foramen was slightly enlarged. In group B and C, after the removal of uncovertebral joint, the medial part of the uncinate process was spurred to fully expose the posterior edge of uncinate process, as well as the inferior and posterior edge of the upper vertebra and the uncovertebral joint space. After that, the inferior-posterior osteophyte of the upper vertebra and the hyperosteogeny part of uncinate process were also spurred. Bone grafting, fusion and internal fixation were performed for all patients after decompression. The bilateral foraminal area of the corresponding segment was measured in double oblique X-ray by Surgimap software, and the comparison between foraminal area of the affected side and the contralateral side was performed. Preoperative and final follow-up VAS and NDI scores of three groups were compared respectively. Operation time, blood loss and hospital stay of the three groups were also compared. Results: Preoperative foraminal area on the contralateral side of the three groups showed no significant difference. Foraminal area on the affected side of group B and C was smaller than that of group A, while group B and group C had no difference. For group B and C, foraminal area on the affected side was smaller than that on the contralateral side, while foraminal area of group A on the affected side showed no difference with that on the contralateral side. Compared with group B and C, group A had younger age, less blood loss, shorter operation time and long hospital stay. No significant difference was found between group B and C. No neurological deterioration, infection or cerebrospinal fluid leakage was found. Fifty-six patients had a follow-up time of over 12 months, with a mean follow-up time of 27.2±8.9 months(range, 12-52 months). There was no significant difference in VAS or NDI score among three groups at preoperation and final follow-up. VAS and NDI of the three groups at the final follow-up were significantly different with those at preoperation. Conclusions: Based on different reasons causing nerve root compression in cervical foramen, targeted decompression procedure may lead to satisfactory clinical outcomes for cervical spondylotic radiculopathy.