Posterior Facetectomy with Fusion Using a Pedicle Screw for Parallel-shaped Cervical Foraminal Stenosis

Abstract

Objective To assess the efficacy and safety of posterior facetectomy with fusion using pedicle screw (PF using FPS) for severe cervical foraminal stenosis of parallel shape. Methods Patients (n=8) with 1- or 2-level parallel-shaped cervical foraminal stenosis who underwent posterior facetectomy with fusion using cervical pedicle screw between March 2012 and August 2016 were enrolled. Patients were followed up immediately postoperatively and at 1, 3, 6, and 12 months postoperatively. We assessed arm and neck pains and clinical outcomes using a numeric rating scale (NRS) and neck disability index (NDI). We determined cervical Cobb's and segmental angles by radiological evaluations. We identified screw breech as a neurovascular complication. Results Neck and arm pains were significantly reduced postoperatively (neck visual analog scale [VAS]: 4.9±3.7 [preoperative] to 0.4±1.1 [final follow-up]; arm VAS: 9.0±0.8 to 0.4±1.1). Cobb's angle for cervical sagittal alignment improved from 11.1±8.4 to 17.0±5.9. Segmental angle of index surgery was maintained (3.4±7.0–4.9±5.6). NDI was also remained from 36.1±26.3 to 13.8±8.4. There are no injuries to the vertebral arteries and neural tissues because of screw insertion. Conclusion PF using FPS is a practical treatment option for parallel-shaped cervical foraminal stenosis.

Anterior decompression of persistent vertebral artery occlusion caused by the cervical facet joint originated osteophyte

“…To this end, both anterior and posterior approaches may achieve VA decompression. However, facetectomy needs to be performed in the posterior approach, while integrity of the facet joints play an important role in the stability of cervical spine 9 , 10 , 11 , internal fixation may need to be performed 12 , which results in postoperative restriction of the neck movements, higher rates of neck pain; and blood loss was also reported 13 . Therefore, we performed anterior decompression surgery to achieve adequate exposure of the VA which results in a complete and direct decompression, while not leading to iatrogenic cervical instability.…”