Abstract: OBJECTIVE: To explore the experience of nerve root decompression with a small posterior paracentral cervical nerve root incision in the treatment of neurogenic cervical spondylosis. METHODS: From January 2007 to May 2008, 34 patients, 22 males and 12 females, aged 48-78 years, with a mean age of 65.5 years, were retrospectively analyzed for neurogenic cervical spondylosis diagnosed according to clinical manifestations and imaging examinations. The preoperative JOA score was 11-14, with a mean score of 12.47±0.915. 33 patients were placed in a semi-sitting position, and one patient was placed in a healthy-side lying position, and a small incision was made in the posterior paracentral cervical area, and the nerve root canal was enlarged and shaped by microscopic grinding and drilling. RESULTS: No postoperative complications occurred, and patients were discharged 3 days after surgery. 32 patients were followed up for 3-14 months after surgery, and 2 patients were lost to follow-up, with a mean follow-up of 6.5 months. The pain disappeared in 30 of the 34 patients with pain before discharge and was significantly reduced in 4 patients; the upper limb muscle strength improved in 19 of the 22 patients with upper limb hypotonia. 32 patients had a JOA score of 15-17 at the three-month postoperative follow-up, with a mean score of 15.88±0.793. Paired t-test was used, t=-17.951, p=0.00 (<0.05). CONCLUSION: The use of posterior paracentral median nerve root decompression with a small incision can effectively treat nerve root type cervical spondylosis and can avoid postoperative axial pain in the neck and shoulder caused by extensive stripping of the posterior cervical muscles and complications caused by anterior cervical spine surgery for vertebral fusion. Chen Zan, Department of Neurosurgery, Xuanwu Hospital, Capital Medical University
Keywords: posterior cervical approach, microneurosurgery, neurogenic cervical spondylosis
The present clinical study showed that the use of posterior cervical nerve root microdecompression for neurogenic cervical spondylosis can effectively treat neurogenic cervical spondylosis with a low rate of postoperative complications, and can avoid postoperative axial pain in the neck and shoulder caused by extensive stripping of the posterior cervical muscles, as well as complications caused by anterior cervical surgery for vertebral fusion.
Figure 1 Wang, female, 42 years old, with right forearm radial pain for 6 months, the patient had grade IV wrist extensor strength on the right side, and MRI showed a herniated C5-6 disc compressing the right C6 nerve root .
Figure 2 Intraoperative decompression of the right C6 nerve root is seen to be adequate for the right C6 nerve root.
Figure 3 Postoperative radiograph shows the effect of enlargement and molding of the right C6 nerve root foramen ( ).
Figure 4 Postoperative CT three-dimensional reconstruction shows the decompression range of the nerve root foramen ( ), and the small joints on the right side of the cervical spine remain intact.