Abstract

PurposeCervical radiculopathy is a common disabling cervical spine condition. Open anterior and posterior approaches are the conventional surgical treatment approaches with good clinical outcomes. However, the soft tissue damage in these procedures can lead to increase perioperative morbidity. Endoscopic spine surgery provides more soft tissue preservation than conventional approaches. We investigate the radiological and clinical outcomes of posterior endoscopic cervical foraminotomy and discectomy.MethodsA prospective clinical and radiological study with retrospective evaluation were done for 25 patients with 29 levels of cervical radiculopathy who underwent posterior endoscopic cervical discectomy from November 2016 to December 2018. Clinical outcomes of Visual Analogue Scale, Neck Disability Index and MacNab’s score were evaluated at pre-operative, post-operative 1 week, 3 months and final follow-up. Preoperative and post-operative final follow-up flexion and extension roentgenogram were evaluated for cervical stability assessment. Pre-operative and post-operative computer tomography cervical spine evaluation of foraminal length in ventro-dorsal, cephalad-caudal dimensions, sagittal foraminal area and using 3D CT reconstruction coronal decompression area were done.ResultsTwenty-nine levels of cervical radiculopathy underwent posterior endoscopic cervical decompression. The mean follow-up was 29.6 months, and the most common levels affected were C5/6 and C6/7. There was a complication rate of 12% with 2 cases of neurapraxia and one case of recurrent of prolapsed disc. There was no revision surgery in our series. There was significant clinical improvement in Visual Analogue Scale and Neck Disability Index. Prospective comparative study between preoperative and final follow-up mean improvement in VAS score was 5.08 ± 1.75, and NDI was 45.1 ± 13.3. Ninety-two percent of the patients achieved good and excellent results as per MacNab’s criteria. Retrospective evaluation of the radiological data showed significant increments of foraminal dimensions: (1) sagittal area increased 21.4 ± 11.2 mm2, (2) CT Cranio Caudal length increased 1.21 ± 1.30 mm and (3) CT ventro-dorsal length increased 2.09 ± 1.35 mm and (4) 3D CT scan reconstruction coronal decompression area increased 536 ± 176 mm2, p < 0.05.ConclusionUniportal posterior endoscopic cervical foraminotomy and discectomy are safe, efficient and precise choreographed set of technique in the treatment of cervical radiculopathy. It significantly improved clinical outcomes and achieved the objective of increasing in the cervical foramen size in our cohort of patients.

Highlights

  • Cervical radiculopathy is a common cervical spine condition which is potentially disabling with nerve root dysfunction [1]

  • There is paucity of literature on radiological evaluation of the amount of foramen decompression achieved by posterior endoscopic cervical decompression by foraminotomy and/or discectomy (PECD)

  • We prospectively followed up a cohort of patients who underwent uniportal posterior full endoscopic cervical decompression by foraminotomy and discectomy for 2 years and retrospectively evaluated their radiological and clinical outcomes

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Summary

Introduction

Cervical radiculopathy is a common cervical spine condition which is potentially disabling with nerve root dysfunction [1]. The development endoscopy started with addressing lumbar spinal issues had evolved to provide solutions for the cervical spine [8] It has the advantage of being a minimally invasive technique which conserves soft tissue, while achieving cervical foraminal decompression and discectomy for prolapsed intervertebral disc and foraminal stenosis [8,9,10]. It may avoid excessive resection of facet which can lead to instability of cervical spine [11]. We prospectively followed up a cohort of patients who underwent uniportal posterior full endoscopic cervical decompression by foraminotomy and discectomy for 2 years and retrospectively evaluated their radiological and clinical outcomes

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