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Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion
Kyung Hyun Kim
Gangnam Severance Hospital
Corresponding Author
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View the published version at BMC Musculoskeletal Disorders.
Background: Many patients with cervical radiculopathy experience stenosis of the neural foramens due to cumulative osteophyte or uncovertebral joint hypertrophy. For cervical foraminal stenosis, complete uncinate process resection (UPR) is often conducted concurrently with anterior discectomy and fusion (ACDF). The aim of this study was to assess the clinical and radiological outcomes of ACDF with complete UPR versus ACDF without UPR.
Methods: In total, 105 patients who performed one-level ACDF with a cage-and-plate construct between 2011 and 2015 were retrospectively reviewed. Among them, 37 patients had ACDF with complete UPR, and 68 patients had ACDF without UPR. Radiologic outcomes of disc height, C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis (SVA), center of the sella turcica–C7 SVA (St-SVA), spino-cranial angle (SCA), and fusion rate were evaluated on plain X-ray at pre-operation, immediately post-operation, and at 2-year follow-up. For statistically matched pairs analysis, ACDF with UPR group (24 patients) and ACDF without UPR (24 patients) were compared.
Results: All of the clinical parameters improved at the 2-year follow up (P<0.0001). Improvement in visual analogue scale (VAS) scores for arm pain was significantly improved in the ACDF with complete UPR group immediately post-operation. All cervical sagittal parameters, including cervical lordosis, segmental angle, disc height, C2-C7 SVA, St-SVA, T1 slope, and SCA, except for preoperative St-SVA, SCA, and disc height of 2 years follow-up, were similar between the ACDF with complete UPR and ACDF without UPR groups. Differences in disc height, C2-C7 SVA, and SCA at 2-year follow up after preoperative examination, however, were statistically significant (p<0.05). Subsidence occurred in 9 patients (ACDF with complete UPR: 8 cases [33%] versus ACDF without UPR: 1 cases [4%]; p < 0.05).
Conclusions: Cervical sagittal alignment after ACDF with complete UPR is not significantly different from that achieved with ACDF without UPR. However, subsidence appears to occur more often after ACDF with complete UPR than after ACDF without UPR, although with little to no clinical impact. More precise and careful selection of patients is needed when deciding on additional complete UPR.
Keywords
Anterior cervical discectomy and fusion, subsidence, uncinate process resection, instability
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CURRENT STATUS: Published
Version 5
Posted 20 Jun, 2020
Published
On 06 Jul, 2020
No community comments so far
Editorial decision: Accept
On 19 Jun, 2020
Editor assigned
On 18 Jun, 2020
Submission checks complete
On 17 Jun, 2020
Editor invited
On 17 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 15 Jun, 2020
Editor assigned
On 07 Jun, 2020
Submission checks complete
On 06 Jun, 2020
Editor invited
On 06 Jun, 2020
No comments provided
Editorial decision: Major revision
On 11 May, 2020
Review #1 received
Received 08 May, 2020
Reviewer #1 agreed
On 17 Apr, 2020
Reviewers invited
Invitations sent on 16 Apr, 2020
Editor assigned
On 19 Mar, 2020
Submission checks complete
On 18 Mar, 2020
Editor invited
On 18 Mar, 2020
No comments provided
Editorial decision: Major revision
On 02 Mar, 2020
Review #2 received
Received 26 Feb, 2020
Reviewers invited
Invitations sent on 25 Feb, 2020
Reviewer #1 agreed
On 25 Feb, 2020
Reviewer #2 agreed
On 25 Feb, 2020
Review #1 received
Received 25 Feb, 2020
Editor assigned
On 03 Feb, 2020
Submission checks complete
On 02 Feb, 2020
Editor invited
On 02 Feb, 2020
No comments provided
Editorial decision: Major revision
On 03 Jan, 2020
Review #2 received
Received 19 Dec, 2019
Reviewer #3 agreed
On 12 Dec, 2019
Review #3 received
Received 12 Dec, 2019
Reviewer #2 agreed
On 26 Nov, 2019
Review #1 received
Received 05 Nov, 2019
Reviewer #1 agreed
On 21 Oct, 2019
Reviewers invited
Invitations sent on 14 Aug, 2019
Editor assigned
On 25 Jul, 2019
Submission checks complete
On 24 Jul, 2019
Editor invited
On 24 Jul, 2019
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This preprint is under consideration at BMC Musculoskeletal Disorders. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Association of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion
Kyung Hyun Kim
Gangnam Severance Hospital
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 5
Posted 20 Jun, 2020
Published
On 06 Jul, 2020
No community comments so far
Editorial decision: Accept
On 19 Jun, 2020
Editor assigned
On 18 Jun, 2020
Submission checks complete
On 17 Jun, 2020
Editor invited
On 17 Jun, 2020
No comments provided
Editorial decision: Minor revision
On 15 Jun, 2020
Editor assigned
On 07 Jun, 2020
Submission checks complete
On 06 Jun, 2020
Editor invited
On 06 Jun, 2020
No comments provided
Editorial decision: Major revision
On 11 May, 2020
Review #1 received
Received 08 May, 2020
Reviewer #1 agreed
On 17 Apr, 2020
Reviewers invited
Invitations sent on 16 Apr, 2020
Editor assigned
On 19 Mar, 2020
Submission checks complete
On 18 Mar, 2020
Editor invited
On 18 Mar, 2020
No comments provided
Editorial decision: Major revision
On 02 Mar, 2020
Review #2 received
Received 26 Feb, 2020
Reviewers invited
Invitations sent on 25 Feb, 2020
Reviewer #1 agreed
On 25 Feb, 2020
Reviewer #2 agreed
On 25 Feb, 2020
Review #1 received
Received 25 Feb, 2020
Editor assigned
On 03 Feb, 2020
Submission checks complete
On 02 Feb, 2020
Editor invited
On 02 Feb, 2020
No comments provided
Editorial decision: Major revision
On 03 Jan, 2020
Review #2 received
Received 19 Dec, 2019
Reviewer #3 agreed
On 12 Dec, 2019
Review #3 received
Received 12 Dec, 2019
Reviewer #2 agreed
On 26 Nov, 2019
Review #1 received
Received 05 Nov, 2019
Reviewer #1 agreed
On 21 Oct, 2019
Reviewers invited
Invitations sent on 14 Aug, 2019
Editor assigned
On 25 Jul, 2019
Submission checks complete
On 24 Jul, 2019
Editor invited
On 24 Jul, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Musculoskeletal Disorders.
Background: Many patients with cervical radiculopathy experience stenosis of the neural foramens due to cumulative osteophyte or uncovertebral joint hypertrophy. For cervical foraminal stenosis, complete uncinate process resection (UPR) is often conducted concurrently with anterior discectomy and fusion (ACDF). The aim of this study was to assess the clinical and radiological outcomes of ACDF with complete UPR versus ACDF without UPR.
Methods: In total, 105 patients who performed one-level ACDF with a cage-and-plate construct between 2011 and 2015 were retrospectively reviewed. Among them, 37 patients had ACDF with complete UPR, and 68 patients had ACDF without UPR. Radiologic outcomes of disc height, C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis (SVA), center of the sella turcica–C7 SVA (St-SVA), spino-cranial angle (SCA), and fusion rate were evaluated on plain X-ray at pre-operation, immediately post-operation, and at 2-year follow-up. For statistically matched pairs analysis, ACDF with UPR group (24 patients) and ACDF without UPR (24 patients) were compared.
Results: All of the clinical parameters improved at the 2-year follow up (P<0.0001). Improvement in visual analogue scale (VAS) scores for arm pain was significantly improved in the ACDF with complete UPR group immediately post-operation. All cervical sagittal parameters, including cervical lordosis, segmental angle, disc height, C2-C7 SVA, St-SVA, T1 slope, and SCA, except for preoperative St-SVA, SCA, and disc height of 2 years follow-up, were similar between the ACDF with complete UPR and ACDF without UPR groups. Differences in disc height, C2-C7 SVA, and SCA at 2-year follow up after preoperative examination, however, were statistically significant (p<0.05). Subsidence occurred in 9 patients (ACDF with complete UPR: 8 cases [33%] versus ACDF without UPR: 1 cases [4%]; p < 0.05).
Conclusions: Cervical sagittal alignment after ACDF with complete UPR is not significantly different from that achieved with ACDF without UPR. However, subsidence appears to occur more often after ACDF with complete UPR than after ACDF without UPR, although with little to no clinical impact. More precise and careful selection of patients is needed when deciding on additional complete UPR.
Figure 1
Figure 2
Figure 3
Figure 4
Figure 5