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.
Objective To explore the anatomical parameters of the cervical uncinate process “inflection point” through cervical CT angiography (CTA) and MRI measurements, offering a reliable and safe anatomical landmark for anterior cervical decompression surgery. Methods A retrospective analysis was conducted on the cervical CTA and MRI imaging data of normal adults who met the selection criteria between January 2020 and January 2024. The CTA dataset included 326 cases, with 200 males and 126 females, aged 22-55 years (mean, 46.7 years). The MRI dataset included 300 cases, with 200 males and 100 females, aged 18-55 years (mean, 43.7 years). Based on the CTA data, three-dimensional models of C3-C7 were constructed, and the following measurements were obtained from the superior view: uncinate process “inflection point” to vertebral artery distance (UIVD), uncinate process tip to vertebral artery distance (UTVD), uncinate process “inflection point” to “inflection point” distance (UID), uncinate process long-axis to sagittal angle (ULSA), and uncinate process “inflection point” to transverse foramen-sagittal angle (UITSA). From the anterior view, the anterior uncinate process to sagittal angle (AUSA) was measured. From the posterior view, the posterior uncinate process to sagittal angle (PUSA) was measured. Based on the MRI data, uncinate process “inflection point” to dural sac distance (UIDD) and dural sac width (DSW) were measured. The trends in measurement parameters of C3-C7 were observed, and the differences in measurement parameters between genders and between the left and right sides of the same segment were compared, as well as the difference in UID and DSW within the same segment was compared. Results The measurement parameters from C3 to C7 in the CTA data showed a general increasing trend, with no significant difference between the left and right sides within the same segment (P>0.05). The UIVD, UTVD, and UID were greater in males than in females, with significant differences observed in the UIVD and UTVD at C3 and C6 and UID at C3, C6, and C7 (P<0.05). The MRI measured DSW showed a general increasing trend from C3 to C7, and the DSW at C6 was greater in females than in males, with a significant difference (P<0.05). The UIDD showed a gradual decreasing trend, with the smallest value at C6. There was no significant difference between males and females or between the left and right sides within the same segment (P>0.05). The UID was greater than the DSW at C3-C7, and the differences were significant (P<0.05). ConclusionThe uncinate process “inflection point” is a constant anatomical structure located at the anteromedial aspect of the uncinate process tip and laterally to the dural sac. It maintains a certain safe distance from the vertebral artery. As a decompression landmark in anterior cervical spine surgery, it not only ensures surgical safety but also guarantees complete decompression.