19. Partial uncinatectomy combined with anterior cervical discectomy and fusion for the treatment of one-level cervical radiculopathy: analysis of clinical efficacy and sagittal alignment

Abstract

BACKGROUND CONTEXT

Biomechanical studies have demonstrated that uncovertebral joint contributes to segment mobility and stability to a certain extent. Simultaneously, osteophytes arising from the uncinate process are a common cause of cervical spondylotic radiculopathy (CSR). For such patients, partial uncinatectomy (UT) may be required. However, the clinical efficacy and sagittal alignment of partial UT during anterior cervical discectomy and fusion (ACDF) have not been fully elucidated.

PURPOSE

This study aims to assess the comparative clinical efficacy, sagittal alignment outcomes, and safety of ACDF with and without partial UT, utilizing zero-profile implants.

STUDY DESIGN/SETTING

A retrospective cohort study comparing clinical and radiological outcomes, and complication rates, following single-level anterior cervical discectomy and fusion with and without partial uncinatectomy.

PATIENT SAMPLE

Eighty-seven patients who underwent single-level ACDF between July 2014 and December 2018 were retrospectively included, divided into groups with (n=37) and without (n=50) partial uncinatectomy.

OUTCOME MEASURES

Outcome measures included preoperative and postoperative clinical scores (VAS, NDI, JOA), radiological parameters of cervical sagittal alignment (C2-7 SVA, St-SVA, T1 slope, cervical lordosis, FSU angle), fusion rate, and the incidence of postoperative complications (dysphagia, adjacent segment degeneration, subsidence).

METHODS

This retrospective cohort study included 87 patients who underwent single-level ACDF between July 2014 and December 2018. Based on surgical technique, patients were divided into two groups: ACDF with partial UT (n=37) and ACDF without UT (n=50). Detailed perioperative data, radiological parameters, clinical outcomes, and complications were analyzed. Key cervical alignment metrics, including C2–7 sagittal vertical axis (SVA) and sella turcica–C7 SVA (St-SVA), were measured preoperatively and at follow-up. Pain and functionality were evaluated using visual analogue scale (VAS) for neck and arm pain, Neck Disability Index (NDI), and Japanese Orthopaedic Association (JOA) scores. Statistical significance was set at p<0.05.

RESULTS

Both groups demonstrated substantial postoperative improvements in pain relief and neurological function. Preoperative VAS arm scores were significantly higher in the UT group (p=0.038), reflecting a more severe symptom burden. Postoperatively, no differences were observed in neck pain VAS, NDI, or fusion rates between groups. At final follow-up, however, patients in the UT group showed reduced recovery in cervical sagittal alignment, with significantly higher residual C2–7 SVA and St-SVA values compared to the non-UT group (p=0.034 and p=0.033, respectively). Both groups experienced comparable rates of complications, including dysphagia, adjacent segment degeneration (ASD), and cage subsidence, with no revision surgeries required.

CONCLUSIONS

Our result indicates that ACDF using a zero-p implant with or without partial UT both provide satisfactory clinical efficacy and acceptable safety. However, additional partial UT may have a negative effect on cervical sagittal alignment.

FDA Device/Drug Status

This abstract does not discuss or include any applicable devices or drugs.