Abstract
Objective Cervical osseous foraminal stenosis (COFS) results from the uncinate process and facet hyperostosis. Currently, the optimal surgical technique for the treatment of COFS remains controversial. Materials and Methods Patients with COFS presenting radiculopathy underwent posterior endoscopic cervical foraminotomy by the circumferential decompression technique. The neck disability index (NDI), the visual analogue scale (VAS), and the modified MacNab criteria were used to evaluate the outcomes. In addition, the range of motion (ROM) and the slippage distance between the operated vertebrae in flexion-extension position were measured to evaluate the stability of the cervical spine. Results There were 24 consecutive patients in the study. The mean follow-up period was 16.2 months (range: 12-26 months). The NDI and VAS scores for arm/neck pain improved significantly from preoperatively to the last follow-up. The satisfaction rate by modified MacNab criteria was 91.7% on the third postoperative day and 100% on the day of final follow-up. There were no significant differences in intervertebral ROM or slippage distance between the last follow-up and preoperatively (P = 0.968, P = 0.394). Arm pain occurred in one patient, and sustained fingers numbness in two patients, but these symptoms resolved at the last follow-up. Conclusions Posterior endoscopic cervical foraminotomy by the circumferential decompression technique is a safe and effective treatment for COFS. Moreover, it preserves the stability and physiological mobility of the cervical spine.
Highlights
Cervical osseous foraminal stenosis (COFS), defined by osseous foraminal narrowing of the cervical spine, is commonly caused by the uncinate process and facet hyperostosis or lateral soft disc herniation [1,2,3]
We proposed a novel circumferential decompression technique based on the “keyhole” approach to treat COFS and evaluated the clinical feasibility, safety, and effectiveness of this technique
The neck disability index (NDI) significantly decreased from 32:7 ± 6:7 preoperatively to 8:6 ± 4:2 at the last followup (P < 0:001)
Summary
Cervical osseous foraminal stenosis (COFS), defined by osseous foraminal narrowing of the cervical spine, is commonly caused by the uncinate process and facet hyperostosis or lateral soft disc herniation [1,2,3]. The progressive narrowing of the intervertebral foramina caused by these pathological changes may lead to nerve root impingement, inflammation, and cervical radiculopathy. There are still different opinions regarding whether the anterior osteophyte from the uncinate process should be removed [4,5,6]. Some researchers [7,8,9,10] have reported that minimally invasive surgery via the anterior approach can remove the osteophyte of the uncinate process and achieve anterior nerve decompression.
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