Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis

Abstract

Objective Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of posterior cervical structures, such as facet joint, cervical kinematics was minimally changed. However, a larger resection of facet joint is required for cervical foraminal stenosis (FS) than disc herniation (DH). The objective was to compare the cervical kinematics between patients with FS and DH after PECF. Methods Consecutive 52 patients (DH, 34 vs. FS, 18) who underwent PECF for single-level radiculopathy were retrospectively reviewed. Clinical parameters (neck disability index, neck pain and arm pain), and segmental, cervical and global radiological parameters were compared at postoperative 3, 6, and 12 months, and yearly thereafter. A linear mixed-effect model was used to assess interactions between groups and time. Any occurrence of significant pain during follow-up was recorded during a mean follow-up period of 45.5 months (range 24–113 months). Results Clinical parameters improved after PECF, with no significant differences between groups. Recurrent pain occurred in 6 patients and surgery (PECF, anterior discectomy and fusion) was performed in 2 patients. Pain-free survival rate was 91% for DH and 83% for FS, with no significant difference between the groups (P = 0.29). Radiological changes were not different between groups (P > 0.05). Segmental neutral and extension curvature became more lordotic. Cervical curvature became more lordotic on neutral and extension X-rays, and the range of cervical motion increased. The mismatch between T1-slope and cervical curvature decreased. Disc height did not change, but the index level showed degeneration at postoperative 2 years. Conclusion Clinical and radiological outcomes after PECF were not different between DH and FS patients and kinematics were significantly improved. These findings may be informative in a shared decision-making process.

Overview and Prevention of Complications During Full-Endoscopic Cervical Spine Surgery

“…The surgical techniques for PECF were consistent with those previously reported [10,[20][21][22][23]25,[28][29][30]. PECF was performed with the patient in the prone position under general anesthesia (Figure 1).…”

“…The requirement for informed consent was waived by IRB for this retrospective study, as it posed no more than minimal risk and would not negatively impact the rights and welfare of the participants. This study included patients with (1) single-or dual-level unilateral radiculopathy due to cervical disc herniation (DH) or foraminal stenosis (FS), (2) a positive Spurling test, (3) disc space narrowing of no more than 50% [26], (4) complete preoperative clinical and radiological data, and (5) postoperative follow-up for more than 1 month [10]. Patients were excluded if they had (1) prior cervical spinal surgery; (2) malignancy, inflammatory joint disease, trauma, psychiatric disease, or neuromuscular disease; or (3) ossification of the posterior longitudinal ligament [10,21,25,27].…”

“…This study included patients with (1) single-or dual-level unilateral radiculopathy due to cervical disc herniation (DH) or foraminal stenosis (FS), (2) a positive Spurling test, (3) disc space narrowing of no more than 50% [26], (4) complete preoperative clinical and radiological data, and (5) postoperative follow-up for more than 1 month [10]. Patients were excluded if they had (1) prior cervical spinal surgery; (2) malignancy, inflammatory joint disease, trauma, psychiatric disease, or neuromuscular disease; or (3) ossification of the posterior longitudinal ligament [10,21,25,27]. For DH cases, foraminal soft DH was confirmed using computed tomography (CT) and magnetic resonance imaging in the absence of evidence of bony FS.…”

“…The surgical level was identified using C-arm fluoroscopy, and an 8-mm skin incision was made above the "V-point," which is formed by the lamina, descending facet, and ascending facet [10,[20][21][22][23]25,29,30]. A dilator (6.9-mm outer diameter), working channel (8.0-mm outer diameter), and endoscope (Vertebris, 4.1-mm working channel; Richard Wolf GmbH, Knittlingen, Germany) were sequentially introduced through the skin incision (Figure 2) [10,[20][21][22][23]25,29,30]. Laminectomy and facetectomy were performed using an endoscopic drill under direct visualization.…”

“…superolateral/inferolateral corner of the nerve root (Figure 3) [10,20,22,25,29,30]. A closed-suction drain was inserted through the working tube, and the skin was closed (Figure 4).…”