Long Term Effect on Adjacent Segment Motion after Posterior Cervical Foraminotomy

Abstract

ObjectivePosterior cervical foraminotomy (PCF) is a motion-preserving surgical technique. The objective was to determine whether PCF alter cervical motion as a long-term influence.MethodsThirty one patients who followed up more than 36 months after PCF for cervical radiculopathy from January 2004 to September 2008 were enrolled in this study. The range of motion (ROM) of whole cervical spine, the operated segment, the cranial and the caudal adjacent segment were obtained. The clinical result and the change of ROMs were compared with those in the patients performed anterior cervical discectomy and fusion (ACDF) during the same period.ResultsIn PCF group, the ROM of whole cervical spine had no significant difference in statistically at preoperative and last follow up. The operated segment ROM was significantly decreased from 11.02±5.72 to 8.82±6.65 (p<0.05). The ROM of cranial adjacent segment was slightly increased from 10.42±5.13 to 11.02±5.41 and the ROM of caudal adjacent segment was decreased from 9.44±6.26 to 8.73±5.92, however these data were not meaningful statistically. In ACDF group, the operated ROM was decreased and unlike in PCF group, especially the ROM of caudal adjacent segment was increased from 9.39±4.21 to 11.33±5.07 (p<0.01).ConclusionAs part of the long-term effects of PCF on cervical motion, the operated segment motions decreased but were preserved after PCF. However, unlikely after ACDF, the ROMs of the adjacent segment did not increase after PCF. PCF, by maintaining the motion of the operated segment, imposes less stress on the adjacent segments. This may be one of its advantages.

Comparison of Anterior Cervical Discectomy and Fusion versus Posterior Cervical Foraminotomy in the Treatment of Cervical Radiculopathy: A Systematic Review

“…The ROM of the operated segment decreased in the ACDF group but was preserved in the PCF group; it was no motion in the ACDF group and 8.82° ± 6.65° in the PCF group, respectively. Meanwhile, the ROM of the adjacent segment increased in the ACDF group but did not increase in the PCF group; the postoperative ROM of the caudal adjacent segment was 11.33° ± 5.07° in the ACDF group and 8.73° ± 5.92° in the PCF group, respectively.…”

“…); 1 trial protocol article and 1 expert opinion article were excluded. The remaining 10 studies were finally included, comprising 3 prospective randomized controlled trails (RCT) and 7 retrospective comparative studies (RCoS). Details of these studies are listed in Table .…”

“…Only 1 RCoS reported on postoperative range of motion (ROM) of cervical spine. The ROM of the operated segment decreased in the ACDF group but was preserved in the PCF group; it was no motion in the ACDF group and 8.82° ± 6.65° in the PCF group, respectively.…”

Anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of brachialgia: the Leeds spinal unit experience (2008–2013)

“…In our series, adjacent-level ACDF was performed in two patients in the ACDF group and this consequence needs to be taken into account during the decision-making process. A recent study by Cho et al [2] demonstrated that in PCF the range of motion in the adjacent segments is preserved, however this certainly was not the case in the ACDF patients. The increased range of motion at the adjacent levels has been postulated as the cause of adjacent segment disease in patients who had ACDF.…”

“…Traditionally, posterior approaches were preferred [7]; however, in recent years anterior approaches are increasingly being favoured as a result of ease of exposure, bilateral decompression, wider access of disc space and, importantly, less patient discomfort [12]. However, the long-term outcomes due to risk of adjacent segment disease, pseudoarthrosis, graft subsidence and kyphosis remain a concern [2,10,12]. These risks are not present with posterior cervical foraminotomy (PCF), which can provide better access to laterally positioned discs and is often less technically challenging.…”