Invasive Cervical Foraminotomy Research Articles

Minimally Invasive Posterior Cervical Foraminotomy: Freiburg Experience With 34 Patients.

Retrospective cohort study. Assessment of outcome after minimally invasive posterior cervical foraminotomy (MI-PCF). Surgical management of cervical radiculopathy represents a controversial area in spinal surgery. Preferred approaches include both anterior cervical discectomy and posterior cervical foraminotomy (PCF). Numerous studies showed comparable results. Employing PCF eliminates risks associated with anterior approach. PCF as originally described by Spurling and Scoville necessitates extensive stripping of cervical muscles to expose the cervical spine, resulting in muscle injury, impaired muscle function, prolonged postoperative neck pain, and increased use of narcotics. There are only few studies investigating outcome after employing MI-PCF. Retrospective review of 34 patients who underwent MI-PCF for presenting complaints, postoperative and follow-up outcome. In the last follow-up the weakness resolved completely in 62.6% of patients, in 4.1% improved and in 16.5% remained unchanged. In the last follow-up 76.7% of patients originally presenting with pain reported complete resolution of pain and 10% reported partial improvement of pain. In total, 23.5% of patients were lost during follow-up as far as pain was concerned. In the last follow-up, 75% of patients achieved relative neck-pain-freedom (Visual Analog Scale≤3) at rest and 62.5% of patients under strain. The mean neck pain on Visual Analog Scale at rest was 2.13 (SD=2.42) and 3.34 (SD=3.01) under strain. In total, 93.8% (n=15) of patients would undergo the same procedure for the same achieved result. Minimally invasive cervical foraminotomy is an effective procedure for decompression of cervical nerve roots regardless the type of the stenosis. Even employing minimally invasive technique still causes neck pain in the long term affecting up to 25% of patients. More randomized control studies are required to clarify the benefits of minimally invasive PCF.

Technique of Minimally Invasive Cervical Foraminotomy.

Posterior cervical foraminotomy is a long utilized and commonly performed procedure, but has been supplanted in many cases by anterior procedures. With the advent of minimally invasive techniques, posterior foraminotomy may again deserve a prominent place in the treatment of cervical foraminal stenosis. To report in detail a successfully utilized minimally invasive technique and the results in a large series of patients, by a single author. The technique is described and illustrated in detail. A retrospective review of the use of this technique in a large series is reported. Precise details of the technique are described with specific attention to complication avoidance. In over 360 cases, there have been no nerve root injuries other than idiopathic C5 palsies, no wound infections, and a single durotomy that required no specific treatment. Minimally invasive posterior cervical foraminotomy is a well-tolerated and effective procedure which can be performed with minimal complications when attention to detail is maintained.

Minimally Invasive Cervical Foraminotomy.

The minimally invasive posterior cervical foraminotomy, a motion-preserving procedure, is an excellent treatment for patients with unilateral radiculopathy secondary to a laterally located herniated disc or foraminal stenosis. Place the patient in a prone position on a Jackson table with 6 posts and with the head resting comfortably on a soft facial pillow, and tape the shoulders down to provide traction to the skin and help with fluoroscopic visualization of the lower cervical levels. Make the skin incision adjacent to the spinous process on the side of the abnormality over the operative level. Use sequential dilators to create a working portal and secure the working tube overlying the lamina-facet junction of the operative level. Perform the laminoforaminotomy with the use of a high-speed drill and a Kerrison rongeur to create a working window into the foramen. Use a nerve hook to superiorly retract the nerve root, and perform a discectomy and decompression. Obtain hemostasis with electrocautery or hemostatic foam and close the wound with a standard layered closure. A systematic review and meta-analysis of studies on open or minimally invasive surgical (MIS) techniques for posterior cervical foraminotomy showed a pooled clinical success rate of 92.7% for the 509 patients managed with the open technique and 94.9% for the 208 patients who had the MIS technique; the difference was not significant (p = 0.418)2.

Treatment of Spinal Conditions in the Young Adult: Endoscopic Cervical Foraminotomy

Minimally invasive cervical foraminotomy procedures have become more prevalent. The goal in treatment of spinal disorders via minimally invasive approaches is motivated by enhancing patient outcome by minimizing pain and complications, facilitating a quicker return to activities, and reducing health care costs. Minimally invasive procedures, specifically microendoscopic foraminotomy surgeries, are excellent for achieving these important goals in young adults. We conducted a literature review of publications regarding endoscopic cervical foraminotomy, as well as including our own experience with the technique. With the development of sequential dilation of muscle fibers using tubular retractor systems and improved endoscopic equipment, minimally invasive procedures can be used safely for posterior cervical decompressions. The semi-sitting position affords decreased blood pooling in the operative field, reduced blood loss, and shorter operative times, and provides improved lateral fluoroscopic images because of the gravity-dependent position of the shoulders. It is critical to identify the correct anatomical level from which the patient׳s radiculopathy originates to achieve surgical success. Minimally invasive procedures, specifically microendoscopic foraminotomy surgeries, are great tools to enhance patient outcome by minimizing pain and complications, facilitating a quicker return to activities, and reducing health care costs. Anterior cervical foraminotomy can be used to treat unilateral radiculopathy; however, there are potential drawbacks with reports of a high reoperation rate. Posterior cervical laminoforaminotomy continues to be an effective option to treat unilateral radiculopathy caused by foraminal stenosis or lateral herniated discs. These minimally invasive procedures have been proven to have success rates equal to or better than those of the traditional open approaches, and are excellent options to treat many patients, especially young adults.

P104. A long-term clinical outcome analysis of minimally invasive cervical foraminotomy for the treatment of cervical radiculopathy

BACKGROUND CONTEXT: Published series of inimally invasive cervical foraminotomy (MICF) have shown excellent short-term relief of cervical radiculopathy (85–98%) with minimal surgical morbidity and blood loss. As reports of this technique have been relatively recent, long-term clinical series documenting the stability of these early results over time. This is the first reported long-term follow-up of MICF patients.