Journal List > J Korean Soc Spine Surg > v.14(2) > 1035793

Kwon: Early Surgical Results of Minimally Invasive Posterior Foraminotomy using Tubular Retractor for Cervical Radiculopathy

Abstract

Study Design

A retrospective review of the clinical and surgical outcomes in 13 patients in which minimally invasive posterior cervical foraminotomy was performed.

Objectives

To report early surgical results of cervical posterior foraminotomy using a tubular retractor with minimally invasive deep muscle splitting. Summary of Literature

Review

In previous studies of the posterior approach, good outcomes were established. The limitations of the posterior approach used to treat compression that was centrally located in the spinal canal were obvious, so the anterior approach was subsequently performed. Moreover, peri-incisional pain and discomfort related to the subperiosteal detachment of the muscle and ligament were the main limitations of this posterior approach. The use of the microendoscope allows very limited exposure with minimal tissue destruction, and has recently been used by various surgeons.

Materials and Methods

Clinical results obtained in 13 patients who underwent posterior foraminotomy from Jan 2005 through Apr 2006 were assessed using a modified Prolo outcome scale. The posterior foraminotomy was performed in a minimally invasive fashion using a tubular retractor with muscle splitting dissection.

Results

Eleven of 13 patients showed immediate relief of radiculopathy. Postoperative posterior cervical pain and spasm were negligible, and no surgically related complication was noted. During the followup period, 12 of 13 patients demonstrated a good outcome based on the modified Prolo outcome scale.

Conclusions

Posterior foraminotomy using a tubular retractor is a minimally invasive surgical option for treating cervical radiculopathy and alleviating post-incisional discomfort on the neck.

REFERENCES

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Figures and Tables%

Fig. 1.
Imaging studies obtained in a 52-year-old woman (Case 2) who presented with severe neck and radicular pain on left upper extremity. Preoperative axial (A) and sagittal (B) T2 weighted MR image demonstrating a left C5-C6 disc herniation (arrow).
jkss-14-67f1.tif
Fig. 2.
Fluoroscopic images representing sequence of steps in dilator (A) and retractor placement (B).
jkss-14-67f2.tif
Fig. 3.
Postoperative images obtained in Case 2. (A) Sagittal T2 weighted MR image showing removal of C5-C6 disc fragment (arrow). (B) Axial CT images showing lamino foraminotomy site. (C) 3 dimensional reconstruction CT images depicting foraminotomy site.
jkss-14-67f3.tif
Table 1.
Modified Prolo functional economic outcome scale
Score Criteria
Economic status
1. Complete invalid
2. No gainful occupation
3. Able to work, but not at previous occupation
4. Working at previous occupation on part-time or limited status
5. Able to work at previous occupation with no restrictions
Functional status
1. Total incapacity (worse than before operation)
2. Persistent neck and arm pain, persistent paresthesias, motor weakness same as prior to operation (able to perform tasks of daily living)
3. Moderate neck and arm pain, persistent paresthesias, minimal motor weakness
4. No neck or arm pain, persistent paresthesias in fingers, no motor weakness
5. No neck or arm pain, no paresthesias, no motor weakness, complete recovery, able to perform previous sports activities
Table 2.
Summary of clinical data and outcome obtained in 13 patients undergoing procedures for cervical radiculopathy
Case No. Age/ Sex Side Level Surgery Duration (mo) VAS score Motor score Outcome F/U (mo)
Radicular Neck
Pre Post Pre Post Pre Post
11 60/M Lt. C7T1 Disc 3 6 0 2 1 5 5 19 (5+4) 24
12 52/F Lt C56 Disc 2.5 7 3 4 2 4 4 18 (5+3) 21
13 55/M Lt. C67 Disc 3 7 0 1 0 4 5 19 (5+4) 21
14 52/M Lt. C56 Disc 4 6 0 2 0 4 5 10 (5+5) 19
15 49/F Lt. C67 Disc 2.5 6 0 3 1 3 5 18 (4+4) 18
16 43/M Lt. C67 Disc 4 8 0 2 1 5 5 19 (5+4) 14
17 43/M Rt. C67 Disc 2 7 0 0 0 5 5 19 (5+4) 13
18 49/M Lt. C67 Disc 2.5 7 2 1 1 5 5 18 (4+4) 14
19 42/M Lt. C56 Fora 3 6 1 1 0 4 5 18 (4+4) 12
10 70/M Rt. C67 Fora 1.5 8 3 4 2 4 4 17 (4+3) 11
11 47/F Rt. C67 Disc 1 8 0 1 0 4 5 19 (5+4) 10
12 44/F Lt. C56 Disc 1 8 1 1 1 4 5 10 (5+5) 10
13 34/M Lt. C67 Fora 20 7 1 1 1 4 5 10 (5+5) 19

disc=discectomy; fora=foraminotomy; VAS=visual analogue scale; Outcome=modified Prolo outcome scale (economic score + functional score)

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