367 Microendoscopic Posterior Cervical Foraminotomy in the Ambulatory Setting: A Longitudinal Experience

Abstract

INTRODUCTION: Posterior cervical foraminotomy (PCF) is a motion-sparing surgical option for unilateral cervical radiculopathy caused by foraminal stenosis. The evolution of microendoscopic (MED) techniques makes it an ideal procedure for the outpatient setting. There are few studies to date that report the safety and efficacy of this procedure specifically in the ambulatory setting. METHODS: This study was a retrospective case series of all patients who underwent MED-PCF at a single ambulatory surgery center over a 6-year period. Standard demographic and perioperative data were collected. Outcome measures included visual analog scale (VAS) pain scores, postoperative complications, 30-day readmission, and need for reoperation at the index or adjacent levels. RESULTS: A total of 825 patients underwent MED-PCF during the 6-year study period. Mean age was 56.5 years. Most patients underwent decompression at C5-6 (260, 31.5%) or C6-7 (426, 51.6%). Eighty-five patients (10.3%) underwent surgery at multiple levels. Mean operative time was 38.0 minutes for single-level cases and 53.1 minutes for multilevel cases. There were no intraoperative or immediate postoperative complications. All patients were discharged home with an approximate length of stay of 3 hours (mean 182.7 ± 44.8 minutes). The vast majority of patients (85.7%) experienced improved VAS pain scores postoperatively and achieved a good or excellent clinical outcome (75.8%) according to the Odom criteria. Almost half (43.5%) had complete resolution of their preoperative pain (ie. postoperative VAS pain score of 0). Very few patients (5, 0.6%) were readmitted within 30 days. Only 46 patients (5.6%) required reoperation at the index level (35, 4.2%), adjacent level (16, 1.9%), or both (5, 0.6%). Mean follow-up was 13.4 months. CONCLUSIONS: MED-PCF can be performed safely in the ambulatory setting with excellent efficacy and low reoperation rates.