Hybrid Surgery for Multilevel Cervical Radiculopathies

Abstract

Introduction Conventional anterior cervical discectomy and fusion (ACDF) operation is the treatment of choice for cervical radiculopathies caused by herniated cervical disc (HCD) or foraminal stenosis (FS) when surgery is indicated. But neck motion limitation and axial neck pain after multilevel ACDF and/or corpectomy and reconstruction would be considerable. For preserving the motion of spinal motion segment, artificial disc transplantation was revolutionary developed, but all of these prosthesis still did not reach to normal angular and sliding range of motion segment, and cause many complications such as prosthesis loosening and migration, subsidence, postoperative kyphosis, progression of facet arthrosis (PFA), heterotopic ossification (HO), and not so much as spontaneous fusion. These device-related failures are still of concern for motion-sparing devices, and moreover, the benefit of these devices in preventing adjacent level degeneration still requires further confirmation. Then anterior cervical microforaminotomy (ACM) which is one of nonfusion surgical technique is applicable method in combination with fusion surgery in other levels for decreasing the numbers of fusion levels on multilevel cervical radiculopathy. The purpose of this study is to introduce alternative surgical technique for minimizing fusion surgery on cases of multilevel cervical radiculopathies as possible. Patients and Methods Patients with bilateral or unilaterally dominant upper extremity radiculopathies, who was defined multilevel pathologies such as HCD or FS on image studies, and underwent ACM combined with ACDF or corpectomy and reconstruction in other levels between December 2010 and May 2012 were included. There were two females and eight males with mean age of 56.86 years. Total number of fusions were15 disc levels including ACDF (13 disc levels) and corpectomy and reconstruction (two disc levels) and total number of ACM were 11 disc levels. Combination surgical techniques were1 level ACDF and 1 level ACM is six cases, 2 level ACDF and 1 level ACM is one case, 3 level ACDF and 1 level ACM is one case, 2 level ACDF and 2 level ACM in one case, and 1 level corpectomy and 1 level ACM is one case. Pre- and postoperative arm, shoulder, and neck pain were evaluated by Visual Analogue Scale (VAS). Functional outcomes were evaluated using Neck Disability Index (NDI). Results Arm and shoulder pain relief was assessed by VAS postoperative immediately and 2, 4, 6 months after procedure. Early postoperatively, there was significant improvement in VAS arm pain ( p < 0.0001). After 1 year, there was also significant improvement in VAS neck pain ( p = 0.001), and VAS arm pain ( p < 0.0001, p = 0.001, respectively). The functional outcome was measured by NDI and relatively good in almost. Major complications such as recurrence of HCD, instrumental failure, or fusion failure were not found and related reoperations were absent in all the cases at this study periods. Conclusion Anterior cervical microforaminotomies are an effective technique for treatment of radiculopathies because of the multilevel degenerative pathologies to minimize the need for fusion.