J Korean Neurosurg Soc.  2014 Sep;56(3):224-229. 10.3340/jkns.2014.56.3.224.

Long-Term Clinical and Radiologic Outcomes of Minimally Invasive Posterior Cervical Foraminotomy

• Kwon YJ

• KMID: 2339961
• DOI: http://doi.org/10.3340/jkns.2014.56.3.224

Abstract

OBJECTIVE
To report long-term clinical and radiological outcomes of minimally invasive posterior cervical foraminotomy (MI-PCF) performed in patients with unilateral single-level cervical radiculopathy.
METHODS
Of forty-six patients who underwent MI-PCF for unilateral single-level radiculopathy between 2005 and 2013, 33 patients were included in the study, with a mean follow-up of 32.7 months. Patients were regularly followed for clinical and radiological assessment. Clinical outcome was measured by visual analogue scale (VAS) for the neck/shoulder and arm, and the neck disability index (NDI). Radiological outcome was measured by focal/global angulation and disc height index (DHI). Outcomes after MI-PCF were evaluated as changes of clinical and radiological parameters from the baseline. Mixed effect model with random patients' effect was used to test for differences in the clinical and radiological parameters repeat measures.
RESULTS
There were no complications and all patients had an uneventful recovery during the early postoperative period. VAS scores for neck/shoulder and arm improved significantly in the early postoperative period (3 months) and were maintained with time (p<0.001). NDI improved significantly post-operatively and tended to decrease gradually during the follow-up period (p<0.001). There were no statistically significant changes in focal and global angulation at follow-up. Percent DHIs of the upper adjacent or operated disc were maintained without significant changes with time. During the follow-up, same site recurrence was not noted and adjacent segment disease requiring additional surgery occurred in two patients (6%) on the contra-lateral side.
CONCLUSION
MI-PCF provides long-term pain relief and functional restoration, accompanied by good long-term radiological outcome.

Keyword

Cervical spine; Foraminotomy; Surgical procedures; Minimally invasive; Radiculopathy; Patient outcome assessment

MeSH Terms

Arm
Follow-Up Studies
Foraminotomy*
Humans
Neck
Patient Outcome Assessment
Postoperative Period
Radiculopathy
Recurrence

Figure

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  Fig. 1 Specially designed retractor and its application into the surgical field. A specially designed muscle retractor (arrow) is located lateral to tubular retractor (A). The operative field through the tube is clear without intervening muscle laterally, due to lateral retraction of the muscle with the retractor (arrow) (B).

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  Fig. 2 Clinical outcomes measured by visual analogue scale (VAS) and neck disability index (NDI). VAS scores of neck/shoulder (nVAS) (A) and arm (aVAS) (B) decrease immediately in the early post-operative period and maintain at plateau with time. NDI (C) tends to decrease more gradually over the follow-up period. The bottom and top of the box are the first quartile and third quartile, and the band inside the box is the median. The circles represent outliers beyond 1.5 interquartile ranges.

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  Fig. 3 Radiological outcomes measured by focal and global angulation. The 3-month follow-up values of focal (A) and global (B) angulation increase slightly from the baseline values, and the other follow-up values are maintained without significant changes. The bottom and top of the box are the first quartile and third quartile, and the band inside the box is the median. The circles represent outliers beyond 1.5 interquartile ranges.

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  Fig. 4 Radiological outcomes measured by disc height index (DHI). Percent DHIs of the upper adjacent (upper DHI) (A) or operated (Op DHI)(B) disc are maintained without changes during the follow-up. The bottom and top of the box are the first quartile and third quartile, and the band inside the box is the median. The circles represent outliers beyond 1.5 interquartile ranges.

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