Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review

Song, Zhaojun; Zhang, Zhi; Hao, Jie; Shen, Jieliang; Zhou, Nian; Xu, Shengxi; Ni, Weidong; Hu, Zhenming

doi:10.1007/s00264-016-3193-4

Cited by 27 publications

(17 citation statements)

References 48 publications

(27 reference statements)

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“…The evolution of minimally invasive solutions to degenerative spine pathologies makes sense to patients who want to get back to life more quickly and may make sense to health care delivery systems as we have to consider how to pay for caring for this aging population. Other studies have shown that microendoscopic minimally invasive cervical foraminotomy is as successful as an open surgical approach for the same disease pathology (12,13). Patients with symptomatic cervical radiculopathy from foraminal stenosis can be effectively managed with either a traditional open or a minimally invasive foraminotomy, and here we describe an endoscopic technique for performing a multilevel posterior cervical foraminotomy that highlights nuances of a procedure that offers both advantages and challenges to the spine surgeon who is trying to take advantage of the newest advances in the growing technology available in minimally invasive spine surgery.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive fully endoscopic two-level posterior cervical foraminotomy: technical note

Wagner¹,

Telfeian²,

Iprenburg³

et al. 2017

J. Spine Surg.

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Posterior cervical foraminotomy is an effective surgical treatment method for relieving radicular symptoms that result from cervical nerve root compression. Minimally invasive techniques and tubular retractor systems are available to minimize tissue retraction, but minimally invasive approaches can carry with them the surgical challenge of trying to pass instruments through a long narrow retractor that is also the port for visualizing the surgical pathology. Herein, the authors present a case of a 65-year-old man who presented with symptoms of a left C6 and C7 radiculopathy and left C5-6 and left C6-7 foraminal narrowing on MRI. A minimally-invasive fully endoscopic left C5-6 and C6-7 posterior foraminotomy was performed through a 1cm outer diameter working channel endoscopic with a 6 mm working channel. Clinicians should be aware that new minimally invasive non-fusion approaches for the treatment of cervical radiculopathy that utilize endoscopic visualization are now coming into use in clinical practice.

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Section: Discussionmentioning

confidence: 99%

Minimally invasive fully endoscopic two-level posterior cervical foraminotomy: technical note

Wagner¹,

Telfeian²,

Iprenburg³

et al. 2017

J. Spine Surg.

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“…While most of the patients who suffered from cervical radiculopathy were treated with conservative management. A good proportion of them failed conservative treatment and fulfilled the indications for surgery [19]. While anterior based procedures such as ACDF and ADR had demonstrated good clinical outcomes, these procedures sacrifice the intervertebral disc in order to achieve their objective of decompression.…”

Section: Discussionmentioning

confidence: 99%

Posterior endoscopic cervical foramiotomy and discectomy: clinical and radiological computer tomography evaluation on the bony effect of decompression with 2 years follow-up

Kim

Lee

et al. 2020

Eur Spine J

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Purpose Cervical radiculopathy is a common disabling cervical spine condition. Open anterior and posterior approaches are the conventional surgical treatment approaches with good clinical outcomes. However, the soft tissue damage in these procedures can lead to increase perioperative morbidity. Endoscopic spine surgery provides more soft tissue preservation than conventional approaches. We investigate the radiological and clinical outcomes of posterior endoscopic cervical foraminotomy and discectomy. Methods A prospective clinical and radiological study with retrospective evaluation were done for 25 patients with 29 levels of cervical radiculopathy who underwent posterior endoscopic cervical discectomy from November 2016 to December 2018. Clinical outcomes of Visual Analogue Scale, Neck Disability Index and MacNab’s score were evaluated at pre-operative, post-operative 1 week, 3 months and final follow-up. Preoperative and post-operative final follow-up flexion and extension roentgenogram were evaluated for cervical stability assessment. Pre-operative and post-operative computer tomography cervical spine evaluation of foraminal length in ventro-dorsal, cephalad-caudal dimensions, sagittal foraminal area and using 3D CT reconstruction coronal decompression area were done. Results Twenty-nine levels of cervical radiculopathy underwent posterior endoscopic cervical decompression. The mean follow-up was 29.6 months, and the most common levels affected were C5/6 and C6/7. There was a complication rate of 12% with 2 cases of neurapraxia and one case of recurrent of prolapsed disc. There was no revision surgery in our series. There was significant clinical improvement in Visual Analogue Scale and Neck Disability Index. Prospective comparative study between preoperative and final follow-up mean improvement in VAS score was 5.08 ± 1.75, and NDI was 45.1 ± 13.3. Ninety-two percent of the patients achieved good and excellent results as per MacNab’s criteria. Retrospective evaluation of the radiological data showed significant increments of foraminal dimensions: (1) sagittal area increased 21.4 ± 11.2 mm2, (2) CT Cranio Caudal length increased 1.21 ± 1.30 mm and (3) CT ventro-dorsal length increased 2.09 ± 1.35 mm and (4) 3D CT scan reconstruction coronal decompression area increased 536 ± 176 mm2, p < 0.05. Conclusion Uniportal posterior endoscopic cervical foraminotomy and discectomy are safe, efficient and precise choreographed set of technique in the treatment of cervical radiculopathy. It significantly improved clinical outcomes and achieved the objective of increasing in the cervical foramen size in our cohort of patients.

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“…The utilization of endoscopy can minimize soft tissue injury. A systematic review by Song et al (14) reported clinical outcomes of micro-endoscopic foraminotomy compared with traditional open method. They identified using of micro-endoscopy have less blood loss and shorter surgical time compared to the standard open surgery.…”

Section: Discussionmentioning

confidence: 99%

Minimally invasive cervical micro-endoscopic foraminotomy for C6 radiculopathy with overlooked scapular winging - A case report -

et al. 2019

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A 73-year-old woman complained of right medial side of scapular pain associated with winged scapula to miss without observing the back in minute detail. Additional treatment was required due to overlooking caused by insufficient examination. We performed micro-endoscopic foraminotomy that provided the disappearance of scapular pain and improvement of winged scapula in relatively early. It was commonly said that winged scapula is an extremely rare condition that causes dysfunction of the upper extremities. We suggest that there are the meaning of winged scapula in diagnosis and the importance of physical examination. Further studies should be required to research the morbidity of winged scapula associated with cervical disease. By sharing our experience of this attention arousing case, we provide information not to repeat the same mistakes. J. Med. Invest. 66 : 340-343, August, 2019

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Microsurgery or open cervical foraminotomy for cervical radiculopathy? A systematic review

Cited by 27 publications

References 48 publications

Minimally invasive fully endoscopic two-level posterior cervical foraminotomy: technical note

Minimally invasive fully endoscopic two-level posterior cervical foraminotomy: technical note

Posterior endoscopic cervical foramiotomy and discectomy: clinical and radiological computer tomography evaluation on the bony effect of decompression with 2 years follow-up

Minimally invasive cervical micro-endoscopic foraminotomy for C6 radiculopathy with overlooked scapular winging - A case report -

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