Cervical Radiculopathy: Focus on Factors for Better Surgical Outcomes and Operative Techniques

Abstract

For patients with cervical radiculopathy, most studies have recommended conservative treatment as the first-line treatment; however, when conventional treatment fails, surgery is considered. A better understanding of the prognosis of cervical radiculopathy is essential to provide accurate information to the patients. If the patients complain of persistent and recurrent arm pain/numbness not respond to conservative treatment, or exhibit neurologic deficits, surgery is performed using anterior or posterior approaches. Anterior cervical discectomy and fusion (ACDF) has historically been widely used and has proven to be safe and effective. To improve surgical outcomes of ACDF surgery, many studies have been conducted on types of spacers, size/height/position of cages, anterior plating, patients’ factors, surgical techniques, and so forth. Cervical disc replacement (CDR) is designed to reduce the incidence of adjacent segment disease during long-term follow-up by maintaining cervical spine motion postoperatively. Many studies on excellent indications for the CDR, proper type/size/shape/height of the implants, and surgical techniques were performed. Posterior cervical foraminotomy is a safe and effective surgical option to avoid complications associated with anterior approach and fusion surgery. Most recent literature demonstrated that all three surgical techniques for patients with cervical radiculopathy have clear advantages and disadvantages and reveal satisfactory surgical outcomes under a proper selection of patients and application of appropriate surgical methods. For this, it is important to fully understand the factors for better surgical outcomes and to adequately practice the operative techniques for patients with cervical radiculopathy.

Posterior Preventive Foraminotomy before Laminectomy Combined with Pedicle Screw Fixation May Decrease the Incidence of C5 Palsy in Complex Cervical Spine Surgery in Patients with Severe Myeloradiculopathy

“…The incidence of C5 palsy was even higher in some studies: 28.9% after posterior laminectomy and fusion in the study reported by Blizzard et al [ 3 , 44 ] and 36.4% after combination surgery in the study by Chang et al [ 45 ]. Although our C5 palsy rates were low, we surmise that the occurrence of this complication may be related to the severity of the foraminal stenosis or the duration of preoperative symptoms, as we used a combined approach in patients with severe stenosis to preserve the foramen height for better foramen decompression, as has been performed in previous studies [ 42 , 46 ]. Thus, it may be impossible to eliminate C5 palsy.…”

Surgical Outcomes of Extensive Dome-Like Laminoplasty Using En Bloc Resection of C2 Inner Lamina for Patients With Severe Cord Compression Behind C2 Body

“…In particular, attention should be paid to the exposure of the facial and hypoglossal nerves, branches of the external carotid, contents of the carotid sheath, and superior laryngeal nerve, and evaluation after surgery is required 23 . In addition, adjacent segment disease should be considered a common and decisive disadvantage of ACDF 24 . The surgical outcomes of various techniques for severe cord compression behind C2 body were demonstrated in Table 3.…”

“…23 In addition, adjacent segment disease should be considered a common and decisive disadvantage of ACDF. 24 The surgical outcomes of various techniques for severe cord compression behind C2 body were demonstrated in Table 3.…”

Assessment of Biomechanical Advantages in Combined Anterior–Posterior Cervical Spine Surgery by Radiological Outcomes: Pedicle Screws over Lateral Mass Screws

“…In this study, we selected patients who had undergone cervical decompression and fusion by the combined anterior-posterior approach as study objects. Our institution considered the combined approach for patients with certain indications based on previous studies [5,[20][21][22][23]. Those indications contained cervical myelopathy and radiculopathy with multilevel spondylosis, severe ossification of the posterior longitudinal ligament (OPLL), congenital stenosis, and multilevel fixed kyphotic deformity.…”