Minimally Invasive Posterior Cervical Foraminotomy

Peto, Ivo; Scheiwe, Christian; Kogias, Evangelos; Hubbe, Ulrich

doi:10.1097/bsd.0000000000000517

Cited by 20 publications

(22 citation statements)

References 32 publications

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“…Instability issues after partial facetectomy during PF may lead problems that require fusion, in general fusion after PF have rates of up to 5%. Recent retrospective studies of minimal invasive PF with over 1000 cases shown that a good level of decompression is achieved, i.e., to same or better NDI in comparison to ACDF [22][23][24][25][26][27][28][29][30][31][32].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

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Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial

Holy

MacDowall

Sigmundsson

et al. 2021

Trials

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Background Cervical radiculopathy is the most common disease in the cervical spine, affecting patients around 50–55 year of age. An operative treatment is common clinical praxis when non-operative treatment fails. The controversy is in the choice of operative treatment, conducting either anterior cervical decompression and fusion or posterior foraminotomy. The study objective is to evaluate short- and long-term outcome of anterior cervical decompression and fusion (ACDF) and posterior foraminotomy (PF) Methods A multicenter prospective randomized controlled trial with 1:1 randomization, ACDF vs. PF including 110 patients. The primary aim is to evaluate if PF is non-inferior to ACDF using a non-inferiority design with ACDF as “active control.” The neck disability index (NDI) is the primary outcome measure, and duration of follow-up is 2 years. Discussion Due to absence of high level of evidence, the authors believe that a RCT will improve the evidence for using the different surgical treatments for cervical radiculopathy and strengthen current surgical treatment recommendation. Trial registration ClinicalTrials.gov NCT04177849. Registered on November 26, 2019

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Section: Background and Rationale {6a}mentioning

confidence: 99%

“…The preserved motion may lead to restenosis as the degeneration continues with the risk of secondary surgery on the index level [34]. PF will lead to clinical success in 64-96% with a reoperation incidence of 4-7% in retrospective cohort studies [22][23][24][25][26][27][28][29][30][31][32][35][36][37].…”

Section: Background and Rationale {6a}mentioning

confidence: 99%

Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial

Holy

MacDowall

Sigmundsson

et al. 2021

Trials

View full text Add to dashboard Cite

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“…In the review done by Church et al [13] among 1,039 patients who underwent PCF, the total number of complications was 36; including 19 surgical site infections, 7 dural tears, 6 patients developed a new focal sensory disturbance, 3 patients had new focal weakness, and 1 scalp laceration from Mayfield head-holder placement. The PCF has also been associated with an increased risk of developing cervical kyphosis due to loss of facet joints integrity [11]. In contrast to this finding, in a biomechanical study on cervical stability following foraminotomy, Zdeblick et al [26] concluded that unilateral foraminotomy with preservation of more than 50% of the facet joint does not result in cervical alignment change.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, it provides direct nerve root decompression with motion preservation of the involved segments [8,11−13]. Potential drawbacks compared with anterior procedures are the risk for postoperative kyphosis and higher risk for infection [11].…”

Section: Introductionmentioning

confidence: 99%

Perioperative complications of inpatient and outpatient single-level posterior cervical foraminotomy: a comparative retrospective study

et al. 2020

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“…c showed right C4/5 uncal hypertrophy and disc protrusion which was decompressed in the same corresponding cut in d or radiological cervical instability, and associated myelopathy with anterior disc herniation and or calcification. Other relative contraindications are calcified disc and ossified posterior longitudinal ligaments [24,25].…”

Section: Discussionmentioning

confidence: 99%

Posterior endoscopic cervical foramiotomy and discectomy: clinical and radiological computer tomography evaluation on the bony effect of decompression with 2 years follow-up

Kim

Lee

et al. 2020

Eur Spine J

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Purpose Cervical radiculopathy is a common disabling cervical spine condition. Open anterior and posterior approaches are the conventional surgical treatment approaches with good clinical outcomes. However, the soft tissue damage in these procedures can lead to increase perioperative morbidity. Endoscopic spine surgery provides more soft tissue preservation than conventional approaches. We investigate the radiological and clinical outcomes of posterior endoscopic cervical foraminotomy and discectomy. Methods A prospective clinical and radiological study with retrospective evaluation were done for 25 patients with 29 levels of cervical radiculopathy who underwent posterior endoscopic cervical discectomy from November 2016 to December 2018. Clinical outcomes of Visual Analogue Scale, Neck Disability Index and MacNab’s score were evaluated at pre-operative, post-operative 1 week, 3 months and final follow-up. Preoperative and post-operative final follow-up flexion and extension roentgenogram were evaluated for cervical stability assessment. Pre-operative and post-operative computer tomography cervical spine evaluation of foraminal length in ventro-dorsal, cephalad-caudal dimensions, sagittal foraminal area and using 3D CT reconstruction coronal decompression area were done. Results Twenty-nine levels of cervical radiculopathy underwent posterior endoscopic cervical decompression. The mean follow-up was 29.6 months, and the most common levels affected were C5/6 and C6/7. There was a complication rate of 12% with 2 cases of neurapraxia and one case of recurrent of prolapsed disc. There was no revision surgery in our series. There was significant clinical improvement in Visual Analogue Scale and Neck Disability Index. Prospective comparative study between preoperative and final follow-up mean improvement in VAS score was 5.08 ± 1.75, and NDI was 45.1 ± 13.3. Ninety-two percent of the patients achieved good and excellent results as per MacNab’s criteria. Retrospective evaluation of the radiological data showed significant increments of foraminal dimensions: (1) sagittal area increased 21.4 ± 11.2 mm2, (2) CT Cranio Caudal length increased 1.21 ± 1.30 mm and (3) CT ventro-dorsal length increased 2.09 ± 1.35 mm and (4) 3D CT scan reconstruction coronal decompression area increased 536 ± 176 mm2, p < 0.05. Conclusion Uniportal posterior endoscopic cervical foraminotomy and discectomy are safe, efficient and precise choreographed set of technique in the treatment of cervical radiculopathy. It significantly improved clinical outcomes and achieved the objective of increasing in the cervical foramen size in our cohort of patients.

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Minimally Invasive Posterior Cervical Foraminotomy

Cited by 20 publications

References 32 publications

Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial

Operative treatment of cervical radiculopathy: anterior cervical decompression and fusion compared with posterior foraminotomy: study protocol for a randomized controlled trial

Perioperative complications of inpatient and outpatient single-level posterior cervical foraminotomy: a comparative retrospective study

Posterior endoscopic cervical foramiotomy and discectomy: clinical and radiological computer tomography evaluation on the bony effect of decompression with 2 years follow-up

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