Comparison of Surgical Results between Soft Ruptured Disc and Foraminal Stenosis Patients in Posterior Cervical Laminoforaminotomy

Abstract

ObjectivePosterior cervical laminoforaminotomy is used to relieve cervical nerve root compression caused by a laterally herniated soft cervical disc or spondylotic spur and its several advantages and disadvantages compared with anterior cervical discectomy were reported. We compared surgical results between soft ruptured disc and foraminal stenosis in posterior cervical laminoforaminotomy.MethodsWe performed a retrospective review of 47 patients performed single level posterior cervical laminoforaminotomy for cervical radiculopathy between 2004 and 2012. We divided these patients into two groups, Group A: 27 patients for ruptured disc and Group B: 20 patients for foraminal stenosis and analyzed the demographic factors, amount of medial facetectomy, postoperative instability with neck pain and clinical outcomes.ResultsAccording to the modified Odom's criteria, laminoforaminotomy for the ruptured disc showed 92.6% excellent results and 7.4% good results. For the foraminal stenosis, it was 55.0% excellent and 25.0% good results, which was statistically significant. However when both groups were included, overall success rate showed 91.5%. The extent of medial facetectomy for ruptured disc (31.2%) was smaller than for stenosis (48.8%) and it was statistically significant. Thirteen patients complained of postoperative neck pain for 2 months. There was no instability on dynamic X-ray until the last follow up period and we had two cases complications (4.3%).ConclusionAlthough the extent of facetectomy for ruptured disc was smaller than it for stenosis, posterior laminoforaminotomy for the ruptured disc showed the better outcomes than foraminal stenosis.

Surgial Result of Patients Undergoing Posterior Cervical Laminoforaminotomy : Retrospektive Study

“…In a study by Henderson (19). In our study also, we found that 93.75% of patients with soft disc were found to have excellent and good results, and in patients with foraminal stenosis, this rate remained at 75%.…”

“…However, it was found that with 50% and more of facetectomies highly likely caused instability (4,5). In the study of Yoo et al, 31.2% of facetectomies was sufficient for the removal of the soft disc, whereas in patients with foraminal stenosis, 48.8% of facetectomies were found to have lower clinical results (19). In our study, the facetectomy rate was 32% in patients with soft disc hernias and 42% in patients with foraminal stenosis.…”

Perspective: Cervical laminoforaminotomy (CLF) is safer than anterior cervical diskectomy/fusion (ACDF) for lateral cervical disease

“…ree studies documented good/excellent postoperative outcomes with limited reports of adverse events following open CLF [Table 1]. [13][14][15] Yilmaz (2016) et al found that performing 83 open CLF to address posterolateral soft discs or foraminal stenosis resulted in 66 excellent and 13 good outcomes (Odom's Criteria); additionally, 79 (95%) showed improvement in postoperative radicular complaints, with just two adverse events (i.e., AE: 1 dural tear, and one wrong level surgery) [Table 1]. [13] Further pros for CLF included; better operative exposure to limit perioperative neural injuries, a shortened LOS, and greater preservation of stability (i.e., avoidance of fusion 1].…”

“…(2017) evaluated the overall outcomes for 27 patients undergoing open CLF for soft disc herniations vs. 20 for lateral/foraminal stenosis, they found both groups exhibited 92.6% excellent and 7.4% good outcomes (Odom’s Criteria), with better results recorded for those with soft discs [ Table 1 ]. [ 15 ]…”

“…Cervical laminoforaminotomy (CLF), whether performed open, minimally invasively (MI), or microendoscopically (ME) for lateral/foraminal cervical disc disease, are safer than anterior cervical diskectomy/fusion (ACDF) [Table 1]. [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16][17] Notably, ACDF risks uniquely include, carotid artery or jugular vein injuries, esophageal tears, dysphagia, tracheal injuries, and recurrent laryngeal nerve injuries not posed by CLF. Further, CLF vs. ACDF offer marked reductions in the frequency of vertebral artery injuries, cord/nerve root deficits, spinal instability, dural tears (DT), tissue damage, operative time, estimated blood loss (EBL), adjacent segment disease, length of stay, and cost.…”