OVER-DISTRACTION DECOMPRESSION AND INTERVERTEBRAL FUSION FOR THE TREATMENT OF CERVICAL FORAMINAL STENOSIS WITH CERVICAL SPONDY-LOTIC RADICULOPATHY

Qingbo Li^{1, #}, Xuwu Li^{2, #}, Lei Cai^{1, #}, Wei Wang¹, Zhengkun Wang¹, Weijun Liu^{1, *} 

¹Department of Orthopaedics, Wuhan Fourth Hospital, Pu Ai Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People’s Republic of China - ²Department of Orthopaedics, Caidian district traditional Chinese medicine hospital, Wuhan, People’s Republic of China 

Objective: To evaluate the clinical efficacy of cervical intervertebral over-distraction decompression and inter-vertebral fusion for the treatment of cervical foraminal stenosis with cervical spondylotic radiculopathy. 

Methods: This prospective analysis of 42 patients with cervical foraminal stenosis and treatment between May 2016 and December 2019 showed clinical manifestations of upper extremity radiation pain and numbness. Examination revealed that the symptoms corresponded to a significant narrowing of the intervertebral space, foraminal stenosis, and hyperplasia of the Luschka joints. All patients underwent anterior cervical discectomy and fusion (ACDF) surgery, involving 52 segments. A high-speed electric drill and 1 mm laminectomy forceps were used to during the operation to remove the medial part, while the lateral Luschka joints were preserved. Cages with an average height of 6.19 mm were selected. After implantation, the cage was implanted into the intervertebral space of the surgical segment, thus in-creasing the intervertebral height by 5.02 mm(Range 4.2- 5.5mm) compared to 1.17 mm(Range 0.3 - 2 mm) before the operation. Then, the surgical segments were fixed. The improvement in neurological function, neck pain, and arm pain were evaluated by JOA(Japanese Orthopaedic Association), VAS(Visual Ana-logue Scale), and NDI(Neck Disability Index). The changes in intervertebral space height, posterior edge height of intervertebral disc space, and intervertebral foramen height before and after operation were compared by CT and 3D(computerized tomography and three-dimentiona ) reconstruction of the cervical spine.

Results: Intervertebral space height increased from 1.17±0.52 mm before the operation to 6.19±0.49 mm in 42 patients. The height of the posterior edge of intervertebral disc space increased from 0.39±0.27 mm to 5.38±0.45 mm, and the height of intervertebral foramen increased from 4.30±0.43 mm to 9.25±0.47 mm. Whereas the anterior-posterior length of the foramen increased from 3.13±0.17 to 4.88±0.19 mm.The symptoms improved significantly after the operation. The VAS of postoperative neck pain decreased from 3.29±0.89 to 0.40±0.54. The VAS of arm pain decreased from 7.29±1.13 to 0.57±0.77, the NDI decreased from 53.14% to 6.10%, and the JOA score of cervical vertebra increased from 12.57±1.11 to 16.76±0.43. These data changes were statistically significant (P<0.001). At the last follow-up, the average loss of intervertebral foramen height due to the collapse of intervertebral space was (0.52) mm. New or aggravated symptoms of neck pain and arm pain did not occur in all patients after the operation. Only 2 patients had mild dysphagia, and the other patients had no complications, and no nonunion was observed at the last follow-up. 

Conclusion: Cervical intervertebral over-distraction and fusion increase the height of the inter-vertebral space and intervertebral foramen, which can indirectly decompress the cervical roots; thus, complete removal of the Luschka joints is not necessary. The postoperative neurological function and pain were significantly improved, and no new or aggravated symptoms of neck pain and arm pain were found. No nonunion and other complications were found. The clinical effect was satisfactory.