Long-term outcomes following anterior foraminotomy for one- or two-level cervical radiculopathy

Abstract

Purpose Anterior foraminotomy (AF) is a surgical treatment for unilateral cervical radiculopathy that avoids fusion-related complications, but its long-term outcome has yet to be investigated. To clarify the efficacy of AF, the author retrospectively collected long-term data regarding the results of this technique. Methods Of 50 patients who underwent AF between November 1999 and June 2005, those who were followed for more than 6 years (n = 44) were enrolled in this study. The parameters studied included the number of revisions, additional surgeries, VAS/NDI, and Odom's criteria. Plain radiographs were also obtained pre-and postoperatively. Results At discharge, 98 % of patients reported improvement, although 20 % temporarily experienced some residual symptoms. There were no other major postoperative complications. At final follow-up (FU, mean of 8.8 years), an excellent or good outcome was achieved in 39 patients (89 %). There was no index level reoperation required, but two additional operations for symptomatic adjacent-segment degeneration were needed (4.5 %). Six patients suffered from shoulder pain on the same side after surgery (mean onset: 3.6 years). At final FU, significant degeneration at the operated level was demonstrated on plain radiographs, resulting in a decreased range of motion. However, loss of lordosis of the segment was minimal. Radiographically, adjacent segment degeneration was noted in only 6 and 11 % at the cranial and caudal segments, respectively.Conclusions In this retrospective study, patients who underwent AF for one-or two-level cervical radiculopathy showed a good long-term outcome with minimal adjacent segment degeneration. However, more data should be collected to clarify possible associations with these findings, such as delayed shoulder problems and aggravation of degeneration at the operated level.

Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review

“…Further, due to extraordinary advances in microsurgery techniques, allowing care and treatment of cervical radiculopathy, microsurgery of the cervical spine has become a focus of research. An increasing number of studies reported little trauma, reduced blood loss, shorter hospital stays faster recovery times and safety and reliability as advantages via microendoscopic foraminotomy [1][2][3][4][5].…”

Radiologic Changes of Operated and Adjacent Segments after Anterior Cervical Microforaminotomy

“…We think that operated segment might be more degenerated to fuse eventually because of the previous advanced spondylosis and the progressive bony regrowth in the foraminotomy site. Park et al14) reported similar results for the ROM and the disc height of operated segment after ACMF in long-term study. They reported that 40 of 43 operated segments (93%) were defined as degenerated in their study, which was larger than our study (30%).…”

Qualidade de vida relacionada à saúde e expectativas com o tratamento cirúrgico de pacientes com estenose espinhal: comparação segundo o local da estenose

“…E para pacientes com problemas na região cervical encontramos médias menores do que 19% (PARK, et al, 2013, CARR et al, 2011.…”

“…E neste período foram realizados tratamentos conservadores, como: fisioterapia e utilização de medicamentos, porém os pacientes não obtiveram resultados positivos e então seus médicos optaram pelo tratamento cirúrgico (CARR et al, 2011;LEITE et al;KRISHNA, et al, 2014;PARK, et al, 2013;YOSHINO;RODRIGUES, 2012).…”

“…Contudo, pesquisadores nesta temática têm proposto estudos que buscam avaliar os benefícios que tratamentos clínicos podem trazer para pacientes com doenças crônico-degenerativas na coluna vertebral, como: fisioterapia, uso de corticoides e analgésicos, acupuntura, bloqueio epidural e mudança de estilo de vida (FRITZ et al, 2013;KONG et al, 2013;PARKER et al, 2014;WEINSTEIN et al, 2010) Na literatura encontramos um valor menor que dois anos de sintomas para pacientes com estenose lombar (PARK, et al, 2013). Muitos estudos internacionais procuram mensurar o início dos sintomas a partir do momento que o paciente começou a sentir dor nas pernas ou dor nas costas, nos pacientes com estenose na região lombar, por exemplo, quando iniciou a dor nas pernas ou nas costas, em relação a estenose lombar, e essa média tem variado de 37 meses a 117 meses antes da cirurgia (KLEINSTUCK, et al, 2009;MANNION, et al, 2009;MANCUSO, et al, 2013).…”