Korean J Neurotrauma.  2017 Oct;13(2):124-129. 10.13004/kjnt.2017.13.2.124.

Comparison of Surgical Results between Soft Ruptured Disc and Foraminal Stenosis Patients in Posterior Cervical Laminoforaminotomy

• Yoo HJ
• Park JH
• Seong HY
• Roh SW

• KMID: 2394546
• DOI: http://doi.org/10.13004/kjnt.2017.13.2.124

Abstract

OBJECTIVE
Posterior cervical laminoforaminotomy is used to relieve cervical nerve root compression caused by a laterally herniated soft cervical disc or spondylotic spur and its several advantages and disadvantages compared with anterior cervical discectomy were reported. We compared surgical results between soft ruptured disc and foraminal stenosis in posterior cervical laminoforaminotomy.
METHODS
We performed a retrospective review of 47 patients performed single level posterior cervical laminoforaminotomy for cervical radiculopathy between 2004 and 2012. We divided these patients into two groups, Group A: 27 patients for ruptured disc and Group B: 20 patients for foraminal stenosis and analyzed the demographic factors, amount of medial facetectomy, postoperative instability with neck pain and clinical outcomes.
RESULTS
According to the modified Odom's criteria, laminoforaminotomy for the ruptured disc showed 92.6% excellent results and 7.4% good results. For the foraminal stenosis, it was 55.0% excellent and 25.0% good results, which was statistically significant. However when both groups were included, overall success rate showed 91.5%. The extent of medial facetectomy for ruptured disc (31.2%) was smaller than for stenosis (48.8%) and it was statistically significant. Thirteen patients complained of postoperative neck pain for 2 months. There was no instability on dynamic X-ray until the last follow up period and we had two cases complications (4.3%).
CONCLUSION
Although the extent of facetectomy for ruptured disc was smaller than it for stenosis, posterior laminoforaminotomy for the ruptured disc showed the better outcomes than foraminal stenosis.

Keyword

Cervical; Facetectomy; Foraminotomy; Posterior; Radiculopathy

MeSH Terms

Constriction, Pathologic*
Demography
Diskectomy
Follow-Up Studies
Foraminotomy
Humans
Neck Pain
Radiculopathy
Retrospective Studies

Figure

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  FIGURE 1 In postoperative computed tomography, we measured length of contralateral facet (A) and length of remnant facet (B) and then, the percentage of facetectomy was calculated as follow, facetectomy (%)=(A−B)×100/A.

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  FIGURE 2 (A) In the ruptured disc case, we pulled out a ruptured disc beneath a root. (B) In the foraminal stenosis case, we performed a more facetectomy compared with ruptured disc for enough nerve decompression.

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  FIGURE 3 Distribution of operation level: the most frequent operation level is C6-7 and the next is C5-6.

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  FIGURE 4 (A) According to the modified Odom's criteria, laminoforaminotomy for the ruptured disc showed 92.6% excellent results and (B) for the foraminal stenosis was 55.0% excellent and 25.0% good results, which was statistically significant (p<0.05). (C) However, when including both groups. overall success rate showed 91.5%.

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  FIGURE 5 Although posterior laminoforaminotomy for the ruptured disc showed the better outcomes than foraminal stenosis. The extent of medial facetectomy for ruptured disc (31.2%) was smaller than for stenosis (48.8%) and it was statistically significant (p<0.05).

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