The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years' clinical and radiographic follow-up

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>This study details long-term clinical and radiographic outcomes following single-level posterior cervical foraminotomy for degenerative disc or osteophyte disease.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>The authors conducted a retrospective review of 162 cases involving patients treated by a single surgeon using a posterior cervical foraminotomy. Inclusion criteria were a minimum of 5 years' clinical and radiographic follow-up and unilateral single-level posterior cervical foraminotomy for degenerative disease between C-3 and C-7. Patients who had undergone previous operations, those who underwent bilateral procedures, and those who underwent foraminotomy as part of a larger laminectomy were excluded. The Neck Disability Index (NDI) was used for clinical follow-up, and radiographic follow-up was performed using static and dynamic lateral radiographs to compare focal and segmental alignment and changes in disc-space height.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>The mean presenting NDI score was 18 (range 2–39). The most common presenting symptoms were radiculopathy (110 patients [68%]), neck pain (85 patients [52%]), and subjective weakness (91 patients [56%]). The mean preoperative focal angulation at the surgically treated level was 4.2° (median 4.1°, range 7.3–15.3°), and the mean preoperative segmental curvature between C-2 and C-7 was 18.0° (median 19.3°, range −22.1 to 39.3°). The mean postoperative NDI score was 8 (range 0–39). Improvement in NDI scores was seen in 150 patients (93%). Resolution of radiculopathy was experienced by 104 patients (95% of patients with radiculopathy). The mean radiographic follow-up was 77.3 months (range 60–177 months). No statistically significant changes in focal or segmental kyphosis or disc-space height were seen among the overall cohort with time (Cox proportional hazards analysis and Student t-test, p &gt; 0.05). The mean postoperative focal angulation was 4.1° (median 3.9°, range −9.9° to 15.1°) and mean postoperative segmental angulation was 17.6° (median 15.4°, range −40.2 to 35.3°). Postoperative instability on dynamic imaging was present in 8 patients (4.9%); 7 of these patients were clinically asymptomatic and were treated conservatively, and 1 required cervical fusion. Postoperative loss of lordosis (defined as segmental Cobb angle &lt; 10°) was seen in 30 patients (20%), 9 of whom had clinical symptoms and 4 of whom required further surgical correction. Factors associated with worsening sagittal alignment (Cox proportional hazards analysis, p &lt; 0.05) included age &gt; 60 at initial surgery, the presence of preoperative cervical lordosis of &lt; 10°, and the need for posterior surgery after the initial foraminotomy</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>The posterior cervical foraminotomy is highly effective in treating patients with cervical radiculopathy and results in long-lasting pain relief and improved quality-of-life outcomes in most patients. Long-term radiographic follow-up shows no significant trend toward kyphosis, although select patient subsets (patients older than 60 years, patients who had previous posterior surgery, and patients with &lt; 10° of lordosis preoperatively) appear to be at higher risk and require closer follow-up.</jats:p></jats:sec>

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

“…Other than the two patients who required additional operations for adjacent-level disorders, only 3 of 42 patients reported a result worse than G/E (fair in all three cases), a success rate comparable with historical long-term PF data [24][25][26][27] and slightly better than those of ACD [19] or ACDF [12,28,29]. The PF is known to be a highly effective procedure for treatment of patients with cervical radiculopathy and results in long-lasting pain relief and improved quality-oflife outcomes in most patients in terms of motion preservation [27,30]. In addition, no significant segmental degeneration or disc space narrowing is seen in AF, but only very small changes in focal or segmental kyphosis and segmental angulation were reported [30].…”

Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study

“…Various anterior and posterior operative approaches for the treatment of cervical radiculopathy have been reported [5,7,8,11,13,16,25,27]. Scoville [23] firstly described posterior foraminotomy through a partial resection of the medial part of facet joint to relieve the compression of the cervical nerve root.…”

“…The posterior approach of cervical disc was originally reported by Mixter [19], and the key-hole foraminotomy was subsequently popularized by Scoville, Epstein, and Fager [5,7,10,11,13,16,25,27]. Many reports noted the term laminoforaminotomy for management of paracentral and foraminal cervical disc.…”

Cervical Radiculopathy: A Review

“…The primary complication with this procedure is neck pain, presumably secondary to muscle dissection [72]. Certain risk factors, such as advanced age, cervical kyphosis, and previous surgery may predispose patients to progressive degeneration and spinal deformity [73]. One of the most important limitations to the posterior surgery is the amount of bony decompression that can safely be achieved.…”