Minimally invasive cervical foraminotomy and diskectomy for laterally located soft disk herniation

Kim, Chi Heon; Kim, Kyoung‐Tae; Chung, Chun Kee; Park, Sung Bae; Yang, Seung Heon; Kim, Sung Mi; Sung, Joo Kyung

doi:10.1007/s00586-015-4198-1

Cited by 71 publications

(92 citation statements)

References 38 publications

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“…All of the patients who had an adequate follow-up have had no recurrence thus far. Some authors reported that preoperative kyphotic SA (cut-off value 1.45°, sensitivity 80%, specificity 73%) seemed to be associated with a poor outcome, however the sample size of the study was only 22 (28). On the univariate analysis clinical factors affecting prognosis in our study, there was no significant difference between the preoperative kyphotic SA (< 1.45°) group and SA (≥ 1.45°) regarding excellent outcomes.…”

Section: E221contrasting

confidence: 62%

Minimally Invasive Full-Endoscopic Posterior Cervical Foraminotomy Assisted by O-Arm-Based Navigation

Zhou

2018

Pain Phys

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Background: Navigated percutaneous endoscopic cervical discectomy (PECD) is a promising minimally invasive surgery for treating cervical spondylotic radiculopathy. PECD has been described as a safe, effective, and minimally invasive method for patients with radiculopathy, but it comes with a steep learning curve. Due to the limited field of vision, anatomic localization is difficult for surgeons until using the O-arm based navigation. In this study, patients with radiculopathy due to foraminal disc herniation or foraminal stenosis in the lower cervical spine underwent the single level full endoscopic posterior cervical foraminotomy procedure assisted by O-arm-based navigation. Objective: The purpose of this study was to evaluate the clinical, radiological outcome and the factors predicting an excellent outcome of patients who underwent full endoscopic posterior cervical foraminotomy procedure assisted by O-arm-based navigation. Study Design: A retrospective analysis of consecutively prospectively collected data. Setting: This study was conducted by a university-affiliated hospital in a major Chinese city. Methods: Forty-two patients who had single-level foraminal disc herniation or foraminal stenosis were retrospectively reviewed. Radicular arm pain was the most common presenting symptom in patients. All patients underwent full-endoscopic posterior cervical foraminotomy assisted by O-arm-based navigation. Clinical outcomes were assessed by the visual analog scale (VAS) for neck and radicular arm pain, neck disability index (NDI), and the short form-36 health survey questionnaire (SF-36) in the immediate preoperative period, immediately postoperative, and at the final follow-up. The clinical parameters and radiological parameters included cervical curvature (CA), segmental angle (SA), and range of motion (ROM), which were assessed preoperatively and at the last follow-up. Results: The mean follow-up for the patients was 15 months. There were no perioperative complications. The VAS score for radicular arm pain and neck pain and the NDI score improved significantly in all of the patients. The SF-36 score reflected significant improvement in all 8 domains. Excellent and good outcomes were achieved in 38 out of 42 patients. The cervical curvature range of motion (CA-ROM) statistically and significantly improved at the final follow-up period compared with the preoperative period. The SA was less kyphotic after PECD at the final follow-up. The postoperative CA and CA-ROM improved but did not significantly change. On the univariate analysis, patients with a symptom duration of less than 3 months had a better outcome than patients with a symptom duration of more than 3 months (excellent, 83.33% vs. 50.00%). Limitations: This was a retrospective study with medium follow-up outcomes (mean 15 months). Conclusions: The results of this study show that the full endoscopic posterior foraminotomy assisted by O-arm-based navigation is a safe and effective option for cervical radiculopathy, with the advantages of a minimally invasive method. Patients with symptom duration less than 3 months had a better outcome than patients with symptom duration more than 3 months. Key words: Minimally invasive, cervical foraminotomy, endoscopic, navigation, O-arm, percutaneous endoscopic cervical discectomy

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Section: E221contrasting

confidence: 62%

Minimally Invasive Full-Endoscopic Posterior Cervical Foraminotomy Assisted by O-Arm-Based Navigation

Zhou

2018

Pain Phys

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“…C urrently, there are various options for the treatment of cervical radiculopathy due to lateral soft disc herniation or foraminal stenosis (1)(2)(3)(4)(5)(6)(7)(8). Analgesic medication, epidural steroid injection, and/or other procedures are the initial treatments of choice, but surgery may be considered when such conservative options are not effective (7,8).…”

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confidence: 99%

Comparison of Cervical Sagittal Alignment and Kinematics after Posterior Full-endoscopic Cervical Foraminotomy and Discectomy According to Preoperative Cervical Alignment

et al. 2017

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Background: The progression of cervical kyphosis due to injury to the facet joints and musculature is a major concern for posterior foraminotomy especially for patients with cervical lordosis of less than 10°. However, cervical hypo-lordosis (cervical lordosis < 10°) may be improved with the alleviation of pain and muscle spasms, which corresponds with the disappearance of a positive Spurling’s test. When surgery is necessary, the spontaneous recovery of cervical curvature may be minimally offset using minimally invasive surgical techniques, such as posterior percutaneous endoscopic cervical foraminotomy (P-PECF). Objectives: The primary objective was to compare the changes in cervical kinematics between patients with cervical lordosis (≥ 10°, group I) and hypo-lordosis (< 10°, group II) after P-PECF. Study Design: This study was a retrospective nested case-control study with the IRB No. H-1210-078-434. Setting: University Medical Center, Seoul, Korea. Methods: P-PECFs were performed for patients with a radiculopathy due to single-level unilateral cervical foraminal soft-disc herniations or foraminal stenosis with minimal degeneration of the disc/facet joints and a positive Spurling’s test. A retrospective nested case-control study was performed for 23 patients with cervical lordosis of ≥ 10° (group I; M:F = 15:8; age, 52.3 ± 9.8 years) and 23 patients with cervical lordosis of < 10°(group II; M:F = 15:8; age, 46.3 ± 12.7 years). P-PECFs were performed using the methods previously reported, and all patients were discharged the next day without limitations on neck motion. The patients were followed at one, 3, 6, and 12 months postoperatively and yearly thereafter. The follow-up period was 25.8 ± 19.6 months. Clinical outcomes were assessed using the visual analogue pain score of arms. The cervical angles (C2-7, tangential method) were measured on neutral (CA), flexion (CAF), and extension (CAE) lateral radiographs, and range of motion (C-ROM) was calculated by conducting a radiological analysis. A linear mixed model was used to assess the linearity of the changes in cervical curvatures during the postoperative 12 months between the groups. Results: Significant reductions in arm pain and negative results on Spurling’s test were initially achieved in 21/23 patients in group I and in 23/23 patients in group II with means of 1.7 ± 0.31 months and 1.09 ± 0.09 months, respectively. Using the mixed effect models, the interactions between group and time were significant for the CA (P = 0.004), CAE (P < 0.001), and C-ROM (P < 0.001) but not the CAF (P = 0.392). The CA (adjusted-P < 0.001), CAE (adjusted-P < 0.001), and C-ROM (adjusted-P = 0.046) exhibited significant between-group differences at the preoperation. However, during the follow-up, these parameters were significantly changed in group II, especially during the postoperative 3 months. The CA, CAE, and C-ROM changed by -11.73°, -19.87°, and 20.32°, respectively. Postoperatively, 17/23 patients in group II and 22/23 patients in group I exhibited cervical lordosis of ≥ 10°. Limitations: This study was retrospective in design, and the inherent selection bias and limited statistical power should be considered.Conclusions: Cervical hypo-lordosis less than 10° may not be a contra-indication for P-PECF when the change of cervical curvature is not a structural change. A larger study is necessary to identify prognostic factors.

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“…In patients suffering from soft lateral disk herniation both minimally invasive techniques show equal results in the patients' outcome and complication rates [9]. Furthermore, recent studies could show good clinical results for endoscopic posterior cervical foraminotomy in patients suffering from bony foraminal stenosis [5,[12][13][14].…”

Section: Discussionmentioning

confidence: 99%

Endoscopic Posterior Cervical Foraminotomy in Bony Stenosis – A Review of the Literature

Hemmer¹,

Oertel²

2017

Int J Neurorehabilitation Eng

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Minimally invasive cervical foraminotomy and diskectomy for laterally located soft disk herniation

Abstract: For patients with foraminal soft-disk herniation, either MTPF or P-PECD, may be regarded as an alternative options to open surgery. Preoperative kyphotic SA (cut-off value 1.45°) seemed to be associated with poor outcome and this may be considered in selecting surgical methods.

Cited by 71 publications

References 38 publications

Minimally Invasive Full-Endoscopic Posterior Cervical Foraminotomy Assisted by O-Arm-Based Navigation

Minimally Invasive Full-Endoscopic Posterior Cervical Foraminotomy Assisted by O-Arm-Based Navigation

Comparison of Cervical Sagittal Alignment and Kinematics after Posterior Full-endoscopic Cervical Foraminotomy and Discectomy According to Preoperative Cervical Alignment

Endoscopic Posterior Cervical Foraminotomy in Bony Stenosis – A Review of the Literature

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