Compressive Cervical Radiculopathy Research Articles

Transtubular anterior cervical foraminotomy for the treatment of compressive cervical radiculopathy: surgical results and complications in a consecutive series of cases

Transtubular anterior cervical foraminotomy for the treatment of compressive cervical radiculopathy: surgical results and complications in a consecutive series of cases

Transtubular Anterior Cervical Foraminotomy for the Treatment of Compressive Cervical Radiculopathy: Surgical Results and Complications in a Consecutive Series of Cases.

Study DesignThis was a retrospective review of patients with compressive cervical radiculopathy treated with a minimally invasive anterior cervical foraminotomy (ACF).PurposeThis study aimed to evaluate the results and complication rates of ACF in a consecutive series of patients and to report our clinical results of ACF as a minimally invasive technique in a series of 45 consecutive patients treated for compressive cervical radiculopathy.Overview of LiteratureACF is a motion-sparing procedure and an alternative to anterior cervical discectomy and fusion (ACDF) and posterior cervical foraminotomy for direct nerve root decompression in patients with compressive cervical radiculopathy.MethodsThe chart review recorded clinical and radiological features preoperatively and postoperatively and at follow-up (FU). The effect of prognostic factors was analyzed in relation to the clinical outcome.ResultsBetween January 2004 and October 2019, 45 patients (15 females and 30 males) with a mean age of 55.9 years (range, 28–78 years) underwent ACF for unilateral cervical radiculopathy. The global clinical outcome according to the MacNab scale was evaluated as excellent in 64.5% of patients (n=29), good in 28.9% (n=13), fair in 4.4% (n=2), and poor in 2.2% (n=1). The radiological FU was available for 73.3% (n=33). The statistical analysis revealed no influence of age, sex, operated level, and side on the clinical outcome. Only one patient (2.2%) exhibited spontaneous bone fusion at the operated level on FU after a right-sided C6–7 ACF with no clinical consequences. No patient presented with signs of delayed segmental instability. The overall reoperation rate of this series was 4.4%.ConclusionsACF is a feasible and low-cost alternative to ACDF in selected patients with cervical radiculopathy. The use of tubular retractors in ACF may confer an added advantage that creates a safe corridor for direct cervical root decompression yet minimizing surrounding soft tissue retraction and avoiding unnecessary bone removal.

Facial Numbness and Paresthesias Resolved with Anterior Cervical Decompression and Fusion

We report 3 patients with classic trigeminal neuropathy (TN) findings, which were due to compressive cervical radiculopathy, and provide a brief anatomic explanation for this association. In each case, left-sided disk herniation between the C5 and C7 levels caused TN and classic (dermatome appropriate) cervical radicular findings, all of which resolved with anterior cervical decompression and fusion (ACDF). To our knowledge, this is the first report of TN caused by radicular compression in the caudal subaxial (C5-C7) cervical spine, which resolved after ACDF.

Painless motor radiculopathy of the cervical spine: clinical and radiological characteristics and long-term outcomes after operative decompression.

OBJECTIVE Various neurological diseases are known to cause progressive painless paresis of the upper limbs. In this study the authors describe the previously unspecified syndrome of compression-induced painless cervical radiculopathy with predominant motor deficit and muscular atrophy, and highlight the clinical and radiological characteristics and outcomes after surgery for this rare syndrome, along with its neurological differential diagnoses. METHODS Medical records of 788 patients undergoing surgical decompression due to degenerative cervical spine diseases between 2005 and 2014 were assessed. Among those patients, 31 (3.9%, male to female ratio 4.8 to 1, mean age 60 years) presented with painless compressive cervical motor radiculopathy due to neuroforaminal stenosis without signs of myelopathy; long-term evaluation was available in 23 patients with 49 symptomatic foraminal stenoses. Clinical, imaging, and operative findings as well as the long-term course of paresis and quality of life were analyzed. RESULTS Presenting symptoms (mean duration 13.3 months) included a defining progressive flaccid radicular paresis (median grade 3/5) without any history of radiating pain (100%) and a concomitant muscular atrophy (78%); 83% of the patients were smokers and 17% patients had diabetes. Imaging revealed a predominantly anterior nerve root compression at the neuroforaminal entrance in 98% of stenoses. Thirty stenoses (11 patients) were initially decompressed via an anterior surgical approach and 19 stenoses (12 patients) via a posterior surgical approach. Overall reoperation rate due to new or recurrent stenoses was 22%, with time to reoperation shorter in smokers (p = 0.033). Independently of the surgical procedure chosen, long-term follow-up (mean 3.9 years) revealed a stable or improved paresis in 87% of the patients (median grade 4/5) and an excellent general performance and quality of life. CONCLUSIONS Painless cervical motor radiculopathy predominantly occurs due to focal compression of the anterior nerve root at the neuroforaminal entrance. Surgical decompression is effective in stabilizing or improving motor function with a resulting favorable long-term outcome.

Ossified Ligamentum Flavum causing Cervical Myelopathy.

Ossification of the ligamentum flavum (OLF) causing compressive cervical myelopathy or radiculopathy is rare. A 50-year-old male was admitted for progressive hypesthesia and paresthesia of both hands and a gradually worsening gait. MRI and CT scans demonstrated ossification of the left ligamentum flavum with dural sac and cord compression at the C5-6 level. The ossified ligamentum flavum was removed through a subtotal laminectomy and left side foraminotomy of the C5-6. Postoperatively, his gait improved remarkably and the sensory symptoms gradually resolved.

A long-term outcome study of 170 surgically treated patients with compressive cervical radiculopathy

There is a general impression that publications in neuro-surgical journals have comprehensively evaluated the relative merits of various operative techniques with long-term follow-up in patients treated for compressive cervical radiculopathy. However, in some 20,000 neurosurgical papers over the past 50 years, only 74 (0.3%) have addressed this common surgical problem. Long-term outcome was assessed by the standardized Functional Economic Outcome Rating Scale of Prolo. Information was obtained primarily by telephone interviews and office visits. No patients were operated upon without a confirmatory neuroradiologic study. Single level soft discs were removed through a posterior-lateral foraminotomy with hemilaminectomy or laminectomy the root was decompressed by the same technique with hard discs. One hundred seventy patients were operated on from 1959-91 with a 96% follow-up. The mean follow-up period was 15 years. Patients who had sedentary occupations and housewives, had statistically higher Economic Prolo scores (p < 0.001) than those who did strenuous work. Of 10 patients with a total Prolo score of 5 or less, seven did strenuous work and had Workers' Compensation claims; the remaining had legal claims or were at psychologic risk for operation. In 86% of patients outcome was good; defined as a Prolo score of 8 in 5%, 9 in 38%, and 10 in 43%. Of 10 recurrences (6%), seven occurred within 3 years after operation and were treated by discectomy and anterior cervical fusion. There were two patients with postoperative deltoid motor weakness who recovered within 1 year. Although outcome studies must have subjective criteria, the Prolo Scale is more objective and quantitative than currently used methods. The posterior approach to disc lesions causing compressive cervical radiculopathy should be compared to other techniques using the Prolo Outcome Scale.

Anterior cervical discectomy without fusion in cervical disc herniation with radicular complaints.

Only cervical disc herniation that provokes root compression unresponsive to conservative treatment should be selected for operation. The operative technique must allow adequate removal of the disc and relieve any root pressure without distressing the patient. Operative decompression of the root can be attained via laminectomy and arthrotomy or by way of an anterior approach. With this second procedure, the ventral discectomy can be done in conjunction with an interbody fusion. We report our experience with 216 patients who unterwent anterior cervical microsurgical discectomy without fusion between 1980 and 1944. All these patients were suffering from compressive cervical radiculopathy caused by disc displacement without significant degenerative deformation of the motion segment and without manifest segmental instability. The follow-up ranged between 6 and 185 months (average 71 months) in the 175 patients in whom it was possible. Only in 7 patients (4 %) is the result unsatisfactory; 79 patients (45 %) are completely free of symptoms 99; (56.6 %) are very satisfied and 45 (25.7 %) satisfied with the result of the procedure.

Micro-technological anterior discectomy without fusion in cervical disk displacement with radicular symptoms

Only cervical disc herniation that provokes root compression unresponsive to conservative treatment should be selected for operation. The operative technique must allow adequate removal of the disc and relieve any root pressure without distressing the patient. Operative decompression of the root can be attained via laminectomy and arthrotomy or by way of an anterior approach. With this second procedure, the ventral discectomy can be done in conjunction with an interbody fusion. We report our experience with 216 patients who underwent anterior cervical microsurgical discectomy without fusion between 1980 and 1944. All these patients were suffering from compressive cervical radiculopathy caused by disc displacement without significant degenerative deformation of the motion segment and without manifest segmental instability. The follow-up ranged between 6 and 185 months (average 71 months) in the 175 patients in whom it was possible. Only in 7 patients (4%) is the result unsatisfactory; 79 patients (45%) are completely free of symptoms 99; (56.6%) are very satisfied and 45 (25.7%) satisfied with the result of the procedure.