Effectiveness analysis of anterior intervertebral osteotomy and fusion assisted by inflection point of uncinate process for treatment of cervical spondylotic myelopathy_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

HU Yiheng ¹ , GE Chenguang ¹ , JIANG Jianfeng ¹ , MA Jun ² , JIANG Xiang ² ,  KANG Hui ²

1. Medical College, Wuhan University of Science and Technology, Wuhan Hubei, 430065, P. R. China;
2. Department of Orthopaedics, General Hospital of Central Theater Command of Chinese PLA, Wuhan Hubei, 430070, P. R. China;

Corresponding?author：

KANG Hui, Email: kanghuicss@163.com

Keywords：

Cervical spondylotic myelopathy; inflection point of the uncinate process; anterior intervertebral osteotomy and fusion; anterior cervical discectomy and fusion

DOI：

10.7507/1002-1892.202604029

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To compare the effectiveness of anterior intervertebral osteotomy and fusion (AIOF), utilizing the inflection point of the uncinate process (IPUP) as an auxiliary positioning landmark, versus conventional anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylotic myelopathy (CSM). Methods A retrospective analysis was conducted on the clinical data of 60 patients with CSM who met the selection criteria and were admitted between June 2021 and December 2024. Among them, 32 patients underwent AIOF using the IPUP as an auxiliary positioning landmark (AIOF group), and 28 patients underwent ACDF (ACDF group). Baseline characteristics—including gender, age, surgical segments, preoperative visual analogue scale (VAS) score for pain, Japanese Orthopaedic Association (JOA) score, cervical lordosis angle, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments—showed no significant difference between the two groups (P>0.05). Operation time, intraoperative blood loss, and the incidence of complications were recorded for both groups. Functional recovery and pain relief were evaluated using JOA and VAS scores preoperatively, at 3 months postoperatively, and at last follow-up. The cervical lordosis angle (C₂-C₇ Cobb angle) and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments were also measured. Interbody fusion and Cage subsidence rates were assessed at last follow-up. Results Operations were successfully completed in all patients, with no significant difference in operation time or intraoperative blood loss between the two groups (P>0.05). Postoperative dysphagia occurred in 2 cases (6.3%) in the AIOF group and 3 cases (10.7%) in the ACDF group, showing no significant difference (P>0.05). Neither group experienced complications such as hoarseness, cerebrospinal fluid leakage, dural tear, spinal cord injury, choking on water, or C₅ nerve root palsy. All patients completed the follow-up, with the follow-up durations of (14.6±2.3) months in the AIOF group and (15.1±2.1) months in the ACDF group, showing no significant difference (t=0.852, P=0.398). No loosening or breakage of internal fixator was observed during follow-up, and complete bony fusion was achieved in all surgical segments. At last follow-up, no Cage subsidence occurred in either group. At 3 months postoperatively and at last follow-up, JOA scores, VAS scores, cervical lordosis angles, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments significantly improved when compared with preoperative values in both groups (P<0.05). Except for the cervical lordosis angle, which showed no significant difference between the two groups (P>0.05), the AIOF group demonstrated superior outcomes compared to the ACDF group in JOA score, VAS score, and the spinal cord cross-sectional area and spinal cord diameter at the surgical segments (P<0.05). Conclusion AIOF using the IPUP as an auxiliary positioning landmark provides satisfactory effectiveness in treating CSM. It is superior to traditional ACDF in improving neurological function, relieving pain, and restoring spinal cord morphology without increasing the risk of complications, representing a safe and effective surgical procedure.

Citation： HU Yiheng, GE Chenguang, JIANG Jianfeng, MA Jun, JIANG Xiang, KANG Hui. Effectiveness analysis of anterior intervertebral osteotomy and fusion assisted by inflection point of uncinate process for treatment of cervical spondylotic myelopathy. Chinese Journal of Reparative and Reconstructive Surgery, 2026, 40(9): 1364-1371. doi: 10.7507/1002-1892.202604029 Copy

1.	Cant DA, Andersen SBK, H?y K. Cervical spondylotic myelopathy[J/OL]. Ugeskr Laeger, 2024, 186(36): V02240149. doi: 10.61409/V02240149.
2.	McCartney S, Baskerville R, Blagg S, et al. Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care[J]. Br J Gen Pract, 2018, 68(666): 44-46.
3.	Chen T, Wang Y, Zhou H, et al. Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament[J/OL]. J Orthop Surg (Hong Kong), 2023, 31(1): 10225536231167704. doi: 10.1177/10225536231167704.
4.	Snyder JT, Tzermiadianos MN, Ghanayem AJ, et al. Effect of uncovertebral joint excision on the motion response of the cervical spine after total disc replacement[J]. Spine (Phila Pa 1976), 2007, 32(26): 2965-2969.
5.	Sun K, Jin L, Zhao B, et al. Radiologic evaluation of uncinate processes of the cervical spine and the relationship between the uncinate process and vertebral artery: Implication in anterior cervical spine surgery[J/OL]. World Neurosurg, 2024, 186: e360-e365. doi: 10.1016/j.wneu.2024.03.141.
6.	Güven?er M, Naderi S, Men S, et al. Morphometric evaluation of the uncinate process and its importance in surgical approaches to the cervical spine: a cadaveric study[J]. Singapore Med J, 2016, 57(10): 570-577.
7.	Lei T, Wang H, Tong T, et al. Enlarged anterior cervical diskectomy and fusion in the treatment of severe localised ossification of the posterior longitudinal ligament[J/OL]. J Orthop Surg Res, 2016, 11(1): 129. doi: 10.1186/s13018-016-0449-z.
8.	Iunes EA, Barletta EA, Barba Belsuzarri TA, et al. Correlation between different interbody grafts and pseudarthrosis after anterior cervical discectomy and fusion compared with control group: Systematic review[J]. World Neurosurg, 2020, 134: 272-279.
9.	王義生. 多節段或“鉗夾型”脊髓型頸椎病手術入路的選擇[J]. 中國脊柱脊髓雜志, 2013, 20(3): 185-186.
10.	Jiang J, Ma J, Su L, et al. Positioning and clinical application of the inflection point of the uncinate process in anterior cervical discectomy and fusion (ACDF): a retrospective study[J]. Eur Spine J, 2025, 34(8): 3314-3325.
11.	van Bilsen MWT, Ullrich C, Ferraris L, et al. Diagnostic accuracy of CT scan-based criteria compared with surgical exploration for the analysis of cervical fusion and nonunion[J]. J Neurosurg Spine, 2020, 33(1): 51-57.
12.	Bisson EF, Mummaneni PV, Michalopoulos GD, et al. Sleep disturbances in cervical spondylotic myelopathy: Prevalence and postoperative outcomes-an analysis from the quality outcomes database[J]. Clin Spine Surg, 2023, 36(3): 112-119.
13.	Sun C, Xiang H, Wu X, et al. The influence of anterior cervical discectomy and fusion surgery on cervical muscles and the correlation between related muscle changes and surgical efficacy[J/OL]. J Orthop Surg Res, 2024, 19(1): 187. doi: 10.1186/s13018-024-04605-2.
14.	Garrido BJ, Wilhite J, Nakano M, et al. Adjacent-level cervical ossification after Bryan cervical disc arthroplasty compared with anterior cervical discectomy and fusion[J]. J Bone Joint Surg (Am), 2011, 93(13): 1185-1189.
15.	宋仁謙, 周英杰, 鄭懷亮, 等. 頸椎前路V形截骨Y形減壓融合術治療后縱韌帶骨化癥的臨床療效觀察[J]. 中國脊柱脊髓雜志, 2017, 34(5): 449-457.
16.	Safaee MM, Nichols NM, Yerneni K, et al. Safety and efficacy of direct nerve root decompression via anterior cervical discectomy and fusion with uncinectomy for cervical radiculopathy[J]. J Spine Surg, 2020, 6(1): 205-209.
17.	Yin R, Jiang W, Chu J, et al. The design and biomechanical study of the 3D-printed implanted cervical vertebral cage[J/OL]. J Orthop Surg Res, 2026, 21(1): 104. doi: 10.1186/s13018-025-06623-0.
18.	Güven?er M, Men S, Naderi S, et al. The V2 segment of the vertebral artery in anterior and anterolateral cervical spinal surgery: a cadaver angiographic study[J]. Clin Neurol Neurosurg, 2006, 108(5): 440-445.
19.	Cui Y, Zhou Y, Liu J, et al. ACDF plus Uncovertebrectomy versus ACDF alone for the treatment of cervical spondylotic radiculopathy: Minimum 5-year follow-up[J]. J Neurol Surg A Cent Eur Neurosurg, 2021, 82(2): 154-160.
20.	Sangari SK, Dossous P, Heineman T, et al. Dimensions and anatomical variants of the foramen transversarium of typical cervical vertebrae[J/OL]. Anat Res Int, 2015, 2015: 391823. doi: 10.1155/2015/391823.
21.	Ye S, Yi J, Li D, et al. Anterior cervical V-Slot decompression and fusion for long-segment cervical ossification of the posterior longitudinal ligament: a follow-up study[J/OL]. Neurosurg Rev, 2025, 48(1): 650. doi: 10.1007/s10143-025-03812-7.
22.	Raveendranath V, Kavitha T, Umamageswari A. Morphometry of the uncinate process, vertebral body, and lamina of the C_3-7 vertebrae relevant to cervical spine surgery[J]. Neurospine, 2019, 16(4): 748-755.
23.	江劍峰, 馬俊, 楊茂宇, 等. 以鉤椎關節“拐點”作為頸椎前路減壓手術定位標志的影像解剖學研究[J]. 中國修復重建外科雜志, 2025, 39(3): 332-340.
24.	Kocabiyik N, Ercikti N, Tunali S. Morphometric analysis of the uncinate processes of the cervical vertebrae[J]. Folia Morphol (Warsz), 2017, 76(3): 440-445.
25.	Jang H, Chin D, Kim K, et al. Does graft position affect subsidence after anterior cervical discectomy and fusion?[J]. Global Spine J, 2022, 12(4): 668-676.

1. Cant DA, Andersen SBK, H?y K. Cervical spondylotic myelopathy[J/OL]. Ugeskr Laeger, 2024, 186(36): V02240149. doi: 10.61409/V02240149.
2. McCartney S, Baskerville R, Blagg S, et al. Cervical radiculopathy and cervical myelopathy: diagnosis and management in primary care[J]. Br J Gen Pract, 2018, 68(666): 44-46.
3. Chen T, Wang Y, Zhou H, et al. Comparison of anterior cervical discectomy and fusion versus anterior cervical corpectomy and fusion in the treatment of localized ossification of the posterior longitudinal ligament[J/OL]. J Orthop Surg (Hong Kong), 2023, 31(1): 10225536231167704. doi: 10.1177/10225536231167704.
4. Snyder JT, Tzermiadianos MN, Ghanayem AJ, et al. Effect of uncovertebral joint excision on the motion response of the cervical spine after total disc replacement[J]. Spine (Phila Pa 1976), 2007, 32(26): 2965-2969.
5. Sun K, Jin L, Zhao B, et al. Radiologic evaluation of uncinate processes of the cervical spine and the relationship between the uncinate process and vertebral artery: Implication in anterior cervical spine surgery[J/OL]. World Neurosurg, 2024, 186: e360-e365. doi: 10.1016/j.wneu.2024.03.141.
6. Güven?er M, Naderi S, Men S, et al. Morphometric evaluation of the uncinate process and its importance in surgical approaches to the cervical spine: a cadaveric study[J]. Singapore Med J, 2016, 57(10): 570-577.
7. Lei T, Wang H, Tong T, et al. Enlarged anterior cervical diskectomy and fusion in the treatment of severe localised ossification of the posterior longitudinal ligament[J/OL]. J Orthop Surg Res, 2016, 11(1): 129. doi: 10.1186/s13018-016-0449-z.
8. Iunes EA, Barletta EA, Barba Belsuzarri TA, et al. Correlation between different interbody grafts and pseudarthrosis after anterior cervical discectomy and fusion compared with control group: Systematic review[J]. World Neurosurg, 2020, 134: 272-279.
9. 王義生. 多節段或“鉗夾型”脊髓型頸椎病手術入路的選擇[J]. 中國脊柱脊髓雜志, 2013, 20(3): 185-186.
10. Jiang J, Ma J, Su L, et al. Positioning and clinical application of the inflection point of the uncinate process in anterior cervical discectomy and fusion (ACDF): a retrospective study[J]. Eur Spine J, 2025, 34(8): 3314-3325.
11. van Bilsen MWT, Ullrich C, Ferraris L, et al. Diagnostic accuracy of CT scan-based criteria compared with surgical exploration for the analysis of cervical fusion and nonunion[J]. J Neurosurg Spine, 2020, 33(1): 51-57.
12. Bisson EF, Mummaneni PV, Michalopoulos GD, et al. Sleep disturbances in cervical spondylotic myelopathy: Prevalence and postoperative outcomes-an analysis from the quality outcomes database[J]. Clin Spine Surg, 2023, 36(3): 112-119.
13. Sun C, Xiang H, Wu X, et al. The influence of anterior cervical discectomy and fusion surgery on cervical muscles and the correlation between related muscle changes and surgical efficacy[J/OL]. J Orthop Surg Res, 2024, 19(1): 187. doi: 10.1186/s13018-024-04605-2.
14. Garrido BJ, Wilhite J, Nakano M, et al. Adjacent-level cervical ossification after Bryan cervical disc arthroplasty compared with anterior cervical discectomy and fusion[J]. J Bone Joint Surg (Am), 2011, 93(13): 1185-1189.
15. 宋仁謙, 周英杰, 鄭懷亮, 等. 頸椎前路V形截骨Y形減壓融合術治療后縱韌帶骨化癥的臨床療效觀察[J]. 中國脊柱脊髓雜志, 2017, 34(5): 449-457.
16. Safaee MM, Nichols NM, Yerneni K, et al. Safety and efficacy of direct nerve root decompression via anterior cervical discectomy and fusion with uncinectomy for cervical radiculopathy[J]. J Spine Surg, 2020, 6(1): 205-209.
17. Yin R, Jiang W, Chu J, et al. The design and biomechanical study of the 3D-printed implanted cervical vertebral cage[J/OL]. J Orthop Surg Res, 2026, 21(1): 104. doi: 10.1186/s13018-025-06623-0.
18. Güven?er M, Men S, Naderi S, et al. The V2 segment of the vertebral artery in anterior and anterolateral cervical spinal surgery: a cadaver angiographic study[J]. Clin Neurol Neurosurg, 2006, 108(5): 440-445.
19. Cui Y, Zhou Y, Liu J, et al. ACDF plus Uncovertebrectomy versus ACDF alone for the treatment of cervical spondylotic radiculopathy: Minimum 5-year follow-up[J]. J Neurol Surg A Cent Eur Neurosurg, 2021, 82(2): 154-160.
20. Sangari SK, Dossous P, Heineman T, et al. Dimensions and anatomical variants of the foramen transversarium of typical cervical vertebrae[J/OL]. Anat Res Int, 2015, 2015: 391823. doi: 10.1155/2015/391823.
21. Ye S, Yi J, Li D, et al. Anterior cervical V-Slot decompression and fusion for long-segment cervical ossification of the posterior longitudinal ligament: a follow-up study[J/OL]. Neurosurg Rev, 2025, 48(1): 650. doi: 10.1007/s10143-025-03812-7.
22. Raveendranath V, Kavitha T, Umamageswari A. Morphometry of the uncinate process, vertebral body, and lamina of the C_3-7 vertebrae relevant to cervical spine surgery[J]. Neurospine, 2019, 16(4): 748-755.
23. 江劍峰, 馬俊, 楊茂宇, 等. 以鉤椎關節“拐點”作為頸椎前路減壓手術定位標志的影像解剖學研究[J]. 中國修復重建外科雜志, 2025, 39(3): 332-340.
24. Kocabiyik N, Ercikti N, Tunali S. Morphometric analysis of the uncinate processes of the cervical vertebrae[J]. Folia Morphol (Warsz), 2017, 76(3): 440-445.
25. Jang H, Chin D, Kim K, et al. Does graft position affect subsidence after anterior cervical discectomy and fusion?[J]. Global Spine J, 2022, 12(4): 668-676.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness analysis of anterior intervertebral osteotomy and fusion assisted by inflection point of uncinate process for treatment of cervical spondylotic myelopathy

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content