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

J Korean Soc Spine Surg. 2007 Jun;14(2):67-72. Korean.
Published online June 30, 2007.  https://doi.org/10.4184/jkss.2007.14.2.67
Copyright © 2007 Korean Society of Spine Surgery
Early Surgical Results of Minimally Invasive Posterior Foraminotomy using Tubular Retractor for Cervical Radiculopathy
Young-Joon Kwon, M.D.
Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University, School of Medicine, Seoul, Korea.

Address reprint requests to: Young-Joon Kwon, M.D. Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Pyeong-dong 108, Jongno-gu, Seoul, 110-746, Korea. Tel: 82-2-2001-2159, Fax: 82-2-2001-2157, Email: neuriac@gmail.com
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 the 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 follow-up 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.

Keywords: Cervical spine; Posterior foraminotomy; Minimally invasive surgery; Radiculopathy

Figures


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).
Click for larger image


Fig. 2
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).
Click for larger image


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.
Click for larger image

Tables


Table 1
Modified Prolo functional economic outcome scale
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Table 2
Summary of clinical data and outcome obtained in 13 patients undergoing procedures for cervical radiculopathy
Click for larger image

References
1. Smith GW, Robinson RA. The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am 1958;40:607–624.
2. Cloward RB. The anterior approach for removal of ruptured cervical disks. J Neurosurg 1958;15:602–617.
3. DePalma AF, Rothman RH, Lewinnek GE, Canale ST. Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 1972;134:755–758.
4. Hilibrand AS, Yoo JU, Carlson GD, Bohlman HH. The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine 1997;22:1574–1579.
5. Foley KT, Smith MM. Microendoscopic discectomy. Tech Neurosurg 1997;3:301–307.
6. Adamson TE. Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg 2001;95:51–57.
7. Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery 2002;51:37–45.
8. Ditunno JF Jr, Young W, Donovan WH, Creasey G. The international standards booklet for neurological and functional classification of spinal cord injury. American Spinal Injury Association. Paraplegia 1994;32:70–80.
9. Davis RA. A long-term outcome study of 170 surgically treated patients with compressive cervical radiculopathy. Surg Neurol 1996;46:523–530.
10. Raynor RB, Pugh J, Shapiro I. Cervical facetectomy and its effect on spine strength. J Neurosurg 1985;63:278–282.
11. Frykholm R. Deformities of dural pouches and strictures of dural sheaths in the cervical region producing nerveroot compression: A contribution to the etiology and operative treatment of brachial neuralgia. J Neurosurg 1947;4:403–413.
12. Scoville WB, Whitcomb BB. Lateral rupture of cervical intervertebral disks. Postgrad Med 1966;39:174–180.
13. Grieve JP, Kitchen ND, Moore AJ, Marsh HT. Results of posterior cervical foraminotomy for treatment of cervical spondylitic radiculopathy. Br J Neurosurg 2000;14:40–43.
14. Kumar GR, Maurice-Williams RS, Bradford R. Cervical foraminotomy: an effective treatment for cervical spondylotic radiculopathy. Br J Neurosurg 1998;12:563–568.
15. Witzmann A, Hejazi N, Krasznai L. Posterior cervical foraminotomy. A follow-up study of 67 surgically treated patients with compressive radiculopathy. Neurosurg Rev 2000;23:213–217.
16. Woertgen C, Holzschuh M, Rothoerl RD, Haeusler E, Brawanski A. Prognostic factors of posterior cervical disc surgery: a prospective, consecutive study of 54 patients. Neurosurgery 1997;40:724–728.
discussion 728-729.
17. Kim KK, Choi BK, Choi CH. Surgical Results of Posterior Laminoforaminotomy and Discectomy for Cervical Disc Herniation. J Korean Neurosurg Soc 2004;36:138–144.
18. Perez-Cruet MJ, Fessler RG, Perin NI. Review: complications of minimally invasive spinal surgery. Neurosurgery 2002;51:26–36.