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Chang CJ, Liu YF, Hsiao YM, Chang WL, Hsu CC, Liu KC, Huang YH, Yeh ML, Lin CL. Full Endoscopic Spine Surgery for Cervical Spondylotic Myelopathy: A Systematic Review. World Neurosurg 2023; 175:142-150. [PMID: 37169077 DOI: 10.1016/j.wneu.2023.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 04/30/2023] [Accepted: 05/01/2023] [Indexed: 05/13/2023]
Abstract
BACKGROUND Cervical spondylotic myelopathy (CSM) may seriously affect quality of life. In the literature, there is scarce evidence of the pros and cons of full endoscopic spine surgery in the treatment of CSM. The main purpose of this study was to conduct a systematic review to elucidate the efficacy of full endoscopic spine surgery in the management of patients with CSM. METHODS This systematic review was conducted in accordance with the PRISMA guidelines. A systematic search of Web of Science, PubMed MEDLINE, Embase, and Cochrane Library was conducted from the database inception to February 1, 2023. RESULTS The study included 183 patients and their age was 56.78 ± 7.87 years. The average surgical time calculated was 96.34 ± 33.58 minutes. Intraoperative blood loss ranged from a minimal amount to 51 mL. The average duration of hospital stay was 3.56 ± 1.6 days. The average span for follow-up was on an interval of 18.7 ± 6.76 months. Significant improvements were noted in all aspects of functional outcomes and image results after full endoscopic cervical spine surgery, with no major complications. CONCLUSIONS The current study found that both anterior transcorporeal and posterior surgical approaches could be used for the treatment of CSM with a full endoscopic technique. Indications of full endoscopic cervical spine surgery for CSM included cervical disc herniation, central canal stenosis, calcified ligamentum flavum, and ossification of the posterior longitudinal ligament. Improved postoperative outcomes with acceptable surgical complications were noted in this systematic review.
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Affiliation(s)
- Chao-Jui Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yuan-Fu Liu
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Yu-Meng Hsiao
- Department of Orthopedics, Tainan Municipal An-Nan Hospital, China Medical University, Tainan, Taiwan
| | - Wei-Lun Chang
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Dou-Liou Branch of National Cheng Kung University Hospital, Yunlin, Taiwan
| | - Che-Chia Hsu
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Keng-Chang Liu
- School of Medicine, Tzu Chi University, Hualien City, Taiwan; Department of Orthopaedic Surgery, Buddhist Dalin Tzu Chi General Hospital, Chiayi, Taiwan
| | - Yi-Hung Huang
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Department of Orthopaedics, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chiayi City, Taiwan
| | - Ming-Long Yeh
- Department of Biomedical Engineering, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University Hospital, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan; Medical Device Innovation Center (MDIC), National Cheng Kung University Hospital, Tainan, Taiwan; Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan.
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The Impact of Single-Level ACDF on Neural Foramen and Disc Height of Surgical and Adjacent Cervical Segments: A Case-Series Radiological Analysis. Brain Sci 2023; 13:brainsci13010101. [PMID: 36672082 PMCID: PMC9857145 DOI: 10.3390/brainsci13010101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 01/01/2023] [Accepted: 01/03/2023] [Indexed: 01/06/2023] Open
Abstract
Background: ACDF has become one of the established procedures for the surgical treatment of symptomatic cervical spondylosis, showing excellent clinical results and effective improvements in neural functions and neck pain relief. The main purpose of ACDF is neural decompression, and it is considered by some authors as an indirect result of the intervertebral distraction and cage insertion and the consequent restoration of the disc space and foramen height. Methods: Radiological data from 28 patients who underwent single-level ACDF were retrospectively collected and evaluated. For neural foramen evaluation, antero-posterior (A-P) and cranio-caudal (C-C) diameters were manually calculated; for intervertebral disc height the anterior, centrum and posterior measurement were calculated. All measurements were performed at surgical and adjacent (above and below) segments. NRS, NDI and also the mJOA and Nurick scale were collected for clinical examination and complete evaluation of patients’ postoperative outcome. Results: The intervertebral disc height in all its measurements, in addition to the height (C-C diameter) of the foramen (both right and left) increase at the surgical segment when comparing pre and postop results (p < 0.001, and p = 0.033 and p = 0.001). NRS and NDI radiculopathy scores showed improved results from pre- to post-op evaluation (p < 0.001), and a negative statistical correlation with the improved disc height at the surgical level. Conclusions: The restoration of posterior disc height through cage insertion appears to be effective in increasing foraminal height in patients with symptomatic preoperative cervical foraminal stenosis.
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Posterior Percutaneous Transpedicular Endoscopic Approach for Treating Single-Segment Cervical Myelopathy. BIOMED RESEARCH INTERNATIONAL 2020; 2020:1573589. [PMID: 33150166 PMCID: PMC7603541 DOI: 10.1155/2020/1573589] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 08/02/2020] [Accepted: 08/10/2020] [Indexed: 12/01/2022]
Abstract
Background Standard posterior percutaneous endoscopic cervical discectomy (PECD) is considered an effective minimally invasive surgery. Although standard PECD can be used to treat radiculopathy with relatively minimal trauma, it is still a challenge to use this approach for treating myelopathy. Objective This report is aimed at first describing a posterior transpedicular approach under endoscopy for myelopathy and evaluating the feasibility and short-term clinical effects of this approach. Methods In our retrospective analysis between Feb. 2016 to Mar. 2017, 16 patients managed with PECD using the posterior transpedicular approach for symptomatic single-segment myelopathy. Surgery involved drilling 1/2 to 2/3 of the medial portion of the pedicle under endoscopy to provide sufficient space and an appropriate angle for inserting the endoscope into the spinal canal, followed by ventral decompression of the spinal cord. Computed tomography and magnetic resonance imaging were used to evaluate pedicle healing and spinal cord decompression. The primary outcomes included a visual analog scale (VAS) scores of axial neck pain and Japanese Orthopaedic Association (JOA) scores of neurological conditions. Results All patients completed a 1-year follow-up examination. The mean duration of surgery was 95.44 ± 19.44 min (52–130 min). The fluoroscopy duration was 5.88 ± 1.05 (4–7). The VAS scores of axial pain significantly improved from 6.94 ± 0.75 preoperatively to 2.88 ± 1.22 postoperatively (P < 0.05). The mean JOA scores improved from 8.50 ± 1.12 preoperatively to 14.50 ± 1.46 at the final follow-up (P < 0.05). The effects were excellent in 8 cases, good in 6 cases, and fair in 2 cases. After partial pedicle excision, the width of the remaining pedicle was 1.70 ± 0.22 mm postoperatively and significantly recovered to 3.38 ± 0.49 mm at the 1-year follow-up. There were no surgery-related complications, such as dural tearing, spinal cord injury, nerve root injury, pedicle fracture, and cervical hematocele or infection. Conclusions The posterior transpedicular approach is an effective method for the treatment of myelopathy in select patients and is a supplement to the described surgical approach for PECD.
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Lara-Reyna J, Yaeger KA, Margetis K. Transpedicular Approach for Ventral Epidural Abscess Evacuation in the Cervical Spine. World Neurosurg 2020; 145:127-133. [PMID: 32950752 DOI: 10.1016/j.wneu.2020.09.062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2020] [Revised: 09/11/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Spinal epidural abscess may require prompt surgical intervention. Ventral cervical abscesses pose a particular challenge regarding the approach for surgical evacuation. The aim of this article was to describe the technical nuances of a posterior transpedicular cervical approach for evacuation of a ventral epidural abscess. METHODS After a standard laminectomy, a foraminotomy was performed to identify the exiting nerve root. Then the medial aspect of the pedicle below the nerve was drilled. This allowed the insertion of a dissector to reach the ventral epidural space and drain the contents in conjunction with suction and irrigation. The posterolateral aspect of the superior endplate of the respective vertebra could be further drilled at this point, allowing access to the disc space with minimal retraction of the exiting nerve root. RESULTS Two patients underwent emergent evacuation of a ventral epidural abscess in the cervical spine using this technique. Radiographic and clinical improvement was evident after evacuation of the abscesses in both cases. CONCLUSIONS Access to the ventral epidural space is feasible using a transpedicular approach in the cervical spine for evacuation of an epidural abscess.
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Affiliation(s)
- Jacques Lara-Reyna
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
| | - Kurt A Yaeger
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Konstantinos Margetis
- Department of Neurological Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, USA
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A Novel Posterior Trench Approach Involving Percutaneous Endoscopic Cervical Discectomy for Central Cervical Intervertebral Disc Herniation. Clin Spine Surg 2019; 32:10-17. [PMID: 29979215 DOI: 10.1097/bsd.0000000000000680] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This report describes a novel posterior trench approach involving percutaneous endoscopic cervical discectomy (PECD) for central cervical intervertebral disc herniation (CIVDH) and an evaluation of the feasibility, safety, and short-term clinical effect of this approach. BACKGROUND CONTEXT Central CIVDH is considered the contraindication for posterior PECD. MATERIALS AND METHODS A single-center retrospective observational study was performed with 30 patients managed with posterior PECD using the trench approach for symptomatic single-level central CIVDH. Primary outcomes included the measures of bodily pain and physical function based on the SF-36 and modified MacNab criteria. Radiographical follow-up included the static and dynamic cervical plain radiographs, computed tomographic scans, and magnetic resonance images. RESULTS A positive clinical response for symptom relief was achieved in all patients. The postoperative MRI showed total removal of the herniated disc. CONCLUSIONS As a supplement to the described surgical techniques of PECD, this trench approach provides novel access for the treatment of CIVDH, especially for the central type. The advantages of this technique include the provision of access to decompress the ventral region of the thecal sac and the ability to avoid damage to the facet joint. The steep learning curve might be a major disadvantage, and the sample volume is a limitation of the study; the effectiveness and reliability of the trench approach should be further verified in a comparative cohort study with a large volume of patients.
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Okazaki T, Nakagawa H, Mure H, Yagi K, Hayase H, Takagi Y, Saito K. Microdiscectomy and Foraminotomy in Cervical Spondylotic Myelopathy and Radiculopathy. Neurol Med Chir (Tokyo) 2018; 58:468-476. [PMID: 30298831 PMCID: PMC6236210 DOI: 10.2176/nmc.oa.2018-0077] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
This study was to assess the efficacy of microdiscectomy, cage fixation, and right tranuncal foramintomy for the patients suffering from right radiulo-myelopathy. Anterior cervical foraminotomy was reported to be an effective option for the treatment of cervical degenerative radiculopathy but with the problem of recurrence. Since Hakuba reported the method of trans-unco-discal approach in 1976, it was designed as keyhole foraminotomy which was called transuncal approach, transpedicular approach or transvertebral approach. In the anterior approach, we usually use the right-sided approach because most of us are right-handed surgeons. We retrospectively investigated our patients who had the right foraminal stenosis causing radiculopathy and were treated with microdiscectomy, cage fixation, and right keyhole transuncal foraminotomy. Since 2011, 23 patients were treated with the manner. All of the 23 patients who had central canal stenosis and among the 23 patients, 8 patients showed only right radiculopathy and 15 patients showed radiculo-myelopathy. In all patients, the radiculopathy disappeared or significantly improved without any complications postoperatively. The average of VAS scores was 7.6 ± 2.2 in preoperative state, 2.8 ± 2.2 at discharge, and 1.1 ± 1.6 in 1 month after surgery. The average of follow-up time was 38.3 months and they had no recurrence of radiculopathy. We showed that this manner is effective and one option for the combined disease of right foraminal and canal stenosis and we believe that this manner is not complex and safe if we can understand the anatomy.
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Affiliation(s)
- Toshiyuki Okazaki
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital.,Department of Neurosurgery, Tokushima University
| | | | - Hideo Mure
- Department of Neurosurgery, Tokushima University
| | - Kenji Yagi
- Department of Neurosurgery, Kawasaki Medical School
| | - Hitoshi Hayase
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
| | | | - Koji Saito
- Department of Neurosurgery, Kushiro Kojinkai Memorial Hospital
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Clark JG, Abdullah KG, Steinmetz MP, Benzel EC, Mroz TE. Minimally Invasive versus Open Cervical Foraminotomy: A Systematic Review. Global Spine J 2011; 1:9-14. [PMID: 24353931 PMCID: PMC3864482 DOI: 10.1055/s-0031-1296050] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2011] [Accepted: 10/13/2011] [Indexed: 11/03/2022] Open
Abstract
Posterior cervical laminoforaminotomy is an effective treatment for cervical radiculopathy due to disc herniations or spondylosis. Over the last decade, minimally invasive (i.e., percutaneous) procedures have become increasingly popular due to a smaller incision size and presumed benefits in postoperative outcomes. We performed a systematic review of the literature and identified studies of open or percutaneous laminoforaminotomy that reported one or more perioperative outcomes. Of 162 publications found by our initial screening, 19 were included in the final analysis. Summative results indicate that patients undergoing percutaneous cervical laminoforaminotomy have lower blood loss by 120.7 mL (open: 173.5 mL, percutaneous: 52.8 mL, n = 670), a shorter surgical time by 50.0 minutes (open: 108.3 minutes, percutaneous: 58.3 minutes, n = 882), less inpatient analgesic use by 25.1 Eq (open: 27.6 Eq, percutaneous: 2.5 Eq, n = 356), and a shorter hospital stay by 2.2 days (open: 3.2 days, percutaneous: 1.0 days, n = 1472), compared with patients undergoing open procedures. However, the heterogeneous nature of published data calls into question the reliability of these summative results. Further structured trials should be conducted to better characterize the risks and benefits of percutaneous laminoforaminotomy.
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Affiliation(s)
| | | | | | | | - Thomas E. Mroz
- Neurological Institute Cleveland Clinic, Cleveland, Ohio
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Lee JY, Löhr M, Impekoven P, Koebke J, Ernestus RI, Ebel H, Klug N. Small keyhole transuncal foraminotomy for unilateral cervical radiculopathy. Acta Neurochir (Wien) 2006; 148:951-8. [PMID: 16804642 DOI: 10.1007/s00701-006-0812-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2005] [Accepted: 04/26/2006] [Indexed: 10/24/2022]
Abstract
Interbody fusion after anterior discectomy may lead to acceleration of degenerative changes at adjacent levels. Although the posterior approach preserves the motion segment, decompression of the nerve root is indirect if "hard disc prolaps" is the main cause. Recently, a technique of microsurgical anterior cervical foraminotomy for the treatment of radiculopathy with preservation of the segment mobility was published. In this study, we present this technique with several modifications.Thirteen patients - 5 men and 8 women with an average age of 49 years - with unilateral radiculopathy resistant to conservative treatment underwent microsurgical anterior foraminotomy via a small keyhole transuncal approach. The base of the uncinate process (UP) was directly drilled in the trajectory to the intervertebral foramen without destroying the disc tissue. The vertebral artery between the transverse process was not exposed. Furthermore, the functional anatomy of the uncovertebral joint remained largely intact. All patients experienced complete relief of radiating pain. A cervical collar was not used. Mean follow-up time was 19 months. The mobility of the operated segment was preserved in each patient. No instability of the cervical spine was seen. The microsurgical anterior foraminotomy via a small keyhole transuncal approach is safe, minimally invasive, and represents an effective method to treat unilateral cervical radiculopathy caused by disc prolaps and/or uncovertebral osteophytes. Additionally, the segment mobility is preserved and prevents the acceleration of degenerative changes at adjacent levels.
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Affiliation(s)
- J-Y Lee
- Department of Neurosurgery, University of Cologne, Cologne, Germany.
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Yilmazlar S, Kocaeli H, Uz A, Tekdemir I. Clinical importance of ligamentous and osseous structures in the cervical uncovertebral foraminal region. Clin Anat 2003; 16:404-10. [PMID: 12903062 DOI: 10.1002/ca.10158] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The vertebral artery, cervical spinal nerves, spinal nerve roots, and the bony and ligamentous tissue related to the cervical vertebrae are structures whose anatomy determines the path of a surgical approach. Defining the anatomy and, in particular, determining the precise location of vulnerable structures at the intervertebral foramen and the uncovertebral foraminal region (UVFR), a region defined by the uncinate process anteriorly, the facet joint posteriorly and the foramen transversarium laterally, has critical significance when selecting the safest surgical approach. We studied the anatomy of the vertebral artery, cervical spinal nerves, and spinal nerve roots within the UVFR in six cadaver specimens. We also obtained measurements of bony structures in 35 dry cervical vertebral columns, from C3-C7. The uncinate process (UP) projects superiorly from the posterolateral aspect of each cervical vertebral body, except for the first and second vertebrae. Because the posterior part of the UP lies adjacent to the vertebral artery, spinal nerve, and spinal nerve roots, its resection creates sufficient space to decompress these structures directly. The posterolateral surface of the UP is covered by ligamentous tissue that originates from the posterior longitudinal ligament and protects the neural and vascular structures during their decompression in the UVFR.
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Affiliation(s)
- Selcuk Yilmazlar
- Department of Neurosurgery, School of Medicine, Uludag University, Bursa, Turkey.
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Posterolateral Disc Herniation. J Neurosurg Spine 2003. [DOI: 10.3171/spi.2003.99.2.0241a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Harrop JS, Silva MT, Sharan AD, Dante SJ, Simeone FA. Cervicothoracic radiculopathy treated using posterior cervical foraminotomy/discectomy. J Neurosurg 2003; 98:131-6. [PMID: 12650396 DOI: 10.3171/spi.2003.98.2.0131] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors conducted a study to identify the effectiveness and morbidity rate associated with treating cervicothoracic disc disease (radiculopathy) via a posterior approach. METHODS Nineteen patients underwent posterior cervicothoracic laminoforaminotomy during a 5.6-year period. Medical records, imaging studies, office charts, hospital records, and phone interview data were reviewed. Specific information analyzed included patient demographics, side of lesion, and conservative treatment, symptoms, and pre- and postoperative pain levels. Pain was rated using a visual analog scale and classified into a radicular and neck component. Data in 19 patients (seven women and 12 men) who underwent 20 procedures (one patient underwent separate bilateral foraminotomies) were analyzed. The mean patient age was 54.8 years (range 38-73 years), and the follow-up period ranged from 23 to 62 months. Symptom duration ranged from 1 to 14 months (mean 3.4 months) and consisted of weakness, numbness, and painful radiculopathies in 11, 16, and 20 cases, respectively. Motor weakness was identified in 11 of 19 patients (mean grade of 4.35), and postoperatively strength normalized in eight of 11 (mean grade of 4.79). The improvement in motor scores was significant (p = 0.007). Pain was the most common presenting symptom. Preoperative radiculopathies were rated between 0 and 10 (mean 7.45), and postoperatively scores were reduced to 0 to 3 (mean 0.2) which was significant (p < 0.0001). Preoperative neck pain was rated between 0 and 8 (mean 2.55), and on follow up ranged from 0 to 2 (mean 0.5), which was also significant (p = 0.001). CONCLUSIONS Posterior cervicothoracic foraminotomy was a safe and effective procedure in the treatment of patients with laterally located disc herniations.
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Affiliation(s)
- James S Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
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Saringer WF, Reddy B, Nöbauer-Huhmann I, Regatschnig R, Reddy M, Tschabitscher M, Knosp E. Endoscopic anterior cervical foraminotomy for unilateral radiculopathy: anatomical morphometric analysis and preliminary clinical experience. J Neurosurg 2003; 98:171-80. [PMID: 12650402 DOI: 10.3171/spi.2003.98.2.0171] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Cervical radiculopathy is typically caused by posterolateral disc herniation or spondylotic foraminal stenosis, either of which may compress the ventral aspect of the nerve root. The authors undertook a study to establish the feasibility of performing an endoscopic approach for anterior cervical foraminotomy (ACFor) in a clinical setting. METHODS Application of this method on cadavers was conducted to verify the practicability of this technique. The clinical study included 16 patients (eight men and eight women; mean age 46.6 years) all presenting with unilateral radicular symptoms (one at two adjacent ipsilateral levels), which were associated with various degrees of neck pain. Disc herniations and/or uncovertebral osteophytes were confirmed on magnetic resonance imaging and high-resolution computerized tomography scanning. A total of 17 endoscopic ACFors (one two-level procedure) were performed using a rigid glass endoscope (25 degrees angled, 3-mm diameter, 10-mm length) mounted on a tubular retractor. No major surgery-related complications were encountered. During a mean follow-up period of 13.8 months an average absolute improvement of 44% (p > 0.05) in the neck disability index score and of 96% (p > 0.05) in the visual analog scale score for radicular pain (compared with the preoperative score) was observed. During the follow-up period strength improved to normal in 84% and sensory deficit in 80% of the patients. The overall subjective patient satisfaction rate was 87.6%; the return-to-work rate after 4 weeks was 81.4%. CONCLUSIONS The advantages of endoscopic ACFor include minimial surgical exposure, improved intraoperative visualization, direct decompression of the nerve root, and the preservation of the intervertebral disc and the motion segment.
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Affiliation(s)
- Walter F Saringer
- Department of Neurosurgery, Anatomical Institute, University of Vienna, Austria.
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