ACDF With Total En Bloc Resection of Uncinate in Foraminal Stenosis of the Cervical Spine: Comparison With Conventional ACDF

Abstract

Study design: This was a prospective cohort study.

Objectives: To find out any differences in clinical outcomes when adding an en bloc total uncinate process resection (TUPR) to conventional anterior cervical discectomy and fusion (ACDF) to relieve an impinged nerve root.

Summary of background data: There has been a long debate on the extent of cervical decompression needed when ACDF is done for patients with foraminal stenosis.

Materials and methods: We included 606 patients who underwent ACDF due to foraminal stenosis. Minimum follow-up was 2 years. Patients with a soft disk herniation, myelopathy, anterior-posterior combined surgery or revision surgery were excluded. There were 275 patients (group U) who underwent ACDF with TUPR and 331 patients (group N) who underwent ACDF without TUPR. Clinical outcome measures were neck pain and arm pain, both assessed using Visual Analog Scale (VAS). We also measured Neck Disability Index (NDI) and patient-reported subjective improvement rate (PRSIR) in percentage. These parameters were measured preoperatively, immediately postoperatively, at 6 weeks as well as 3, 6, 9, 12 and 24 months. Statistical analysis was performed using independent sample t test and paired sample t test.

Results: Preoperative neck and arm pain, and NDI were similar between the 2 groups. All 4 parameters in both groups improved significantly at 6 weeks follow-up and the improved outcomes were maintained up to the 24 month follow-up. There were no significant differences between the 2 groups in overall neck pain VAS, NDI, and PRSIR. There was a significant difference in arm pain VAS statistically all throughout the follow-up period, with group U having lesser arm pain.

Conclusions: Overall clinical outcomes were significantly improved after the ACDF whether an en bloc uncinate process resection was added or not. However, arm pain VAS was significantly less statistically in the uncinate resection group at all times.