Minimally Invasive Posterior Cervical Foraminotomy as an Alternative to Anterior Cervical Discectomy and Fusion for Unilateral Cervical Radiculopathy

Sahai, Nikhil; Changoor, Stuart; Dunn, Conor; Sinha, Kumar; Hwang, Ki Soo; Faloon, Michael; Emami, Arash

doi:10.1097/brs.0000000000003156

Cited by 52 publications

(60 citation statements)

References 32 publications

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“…The 12% complication rate of this cohort was comparable to other minimally invasive posterior cervical foraminotomy and anterior cervical discectomy and fusion literature [4,10,31,32]. The most common complications in the literature related to posterior cervical foraminotomy are wound issues, neuropraxia and durotomy.…”

Section: Discussionsupporting

confidence: 56%

“…The most common complications in the literature related to posterior cervical foraminotomy are wound issues, neuropraxia and durotomy. PECD has good potential in decreasing wound related complications due to its ability to preserve soft tissue and avoid prolonged retraction of any particular cervical muscle group due to constant mobility of endoscope [31]. Incidental durotomy can be a problem in any endoscopic or open procedure, a patch blocking repair technique for small incidental dura tear is a common strategy in treatment of endoscopic dura tear [33].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionsupporting

confidence: 56%

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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“… 16 , 30 A recent meta-analysis, with relatively short follow-up times, found greater improvement of radicular symptoms after foraminotomy, yet no difference in the reoperation rates between foraminotomy and ACDF. 34 …”

Section: Discussionmentioning

confidence: 99%

Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015

et al. 2020

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BACKGROUND Surgery for degenerative cervical spine disease has escalated since the 1990s. Fusion has become the mainstay of surgery despite concerns regarding adjacent segment degeneration. The patient-specific trends in reoperations have not been studied previously. OBJECTIVE To analyze the occurrence, risk factors, and trends in reoperations in a long-term follow-up of all the patients operated for degenerative cervical spine disease in Finland between 1999 and 2015. METHODS The patients were retrospectively identified from the Hospital Discharge Registry. Reoperations were traced individually; only reoperations occurring >365 d after the primary operation were included. Time trends in reoperations and the risk factors were analyzed by regression analysis. RESULTS Of the 19 377 identified patients, 9.2% underwent a late reoperation at a median of 3.6 yr after the primary operation. The annual risk of reoperation was 2.4% at 2 yr, 6.6% at 5 yr, 11.1% at 10 yr, and 14.2% at 15 yr. Seventy-five percent of the late reoperations occurred within 6.5 yr of the primary operation. Foraminal stenosis, the anterior cervical decompression and fusion (ACDF) technique, male gender, weak opiate use, and young age were the most important risk factors for reoperation. There was no increase in the risk of reoperations over the follow-up period. CONCLUSION The risk of reoperation was stable between 1999 and 2015. The reoperation risk was highest during the first 6 postoperative years and then declined. Patients with foraminal stenosis had the highest risk of reoperation, especially when ACDF was performed.

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“…[ 12 ] These 2 references were used to compare the results for MI-PCF reported in Sahai's study. [ 10 ] The overlap in the 95% CIs of the 2 cohorts indicated there was no significant difference at the P < .05 level.…”

Section: Methodsmentioning

confidence: 99%

“…PECF has many advantages, including preserving discs and motion, avoiding graft-related complications and reducing adjacent segmental disease. Recently, Sahai et al [ 10 ] conducted a meta-analysis that compared minimally invasive PCF (PECF included) and ACDF, and the results showed that compared with ACDF, minimally invasive PCF may be effective and safe. To our knowledge, no meta-analysis study has previously been performed to compare outcomes between ACDF and PECF.…”

Section: Introductionmentioning

confidence: 99%

Percutaneous endoscopic cervical foraminotomy as a new treatment for cervical radiculopathy

2020

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Background: Anterior cervical discectomy and fusion (ACDF) is the gold standard treatment for this cervical radiculopathy. Posterior endoscopic cervical foraminotomy (PECF), an effective alternative to ACDF, is becoming widely used by an increasing number of surgeons. However, comparisons of the clinical outcomes of ACDF and PECF remain poorly explored. The purpose of this study was to evaluate and compare visual analog scale (VAS)-arm scores, VAS-neck scores, neck disability index (NDI) scores, reoperation, and complications in PECF and ACDF. Materials and Methods: We comprehensively searched electronic databases or platforms, including PubMed, Web of Science, EMBASE, and the Cochrane Controlled Trial Center, using the PRISMA guidelines. The required information, including VAS-arm scores, VAS-neck scores, NDI scores, reoperation, and complications, was extracted from qualified studies and independently tested and compared by 2 researchers. The methodological index for nonrandomized studies was used to evaluate study quality. Results: Nine studies consisting of 230 males and 256 females were included. The mean age of the included patients was 49.6 years, and the mean follow-up time was 20.6 months. The VAS-arm scores were significantly higher, and VAS-neck scores and NDI scores of PECF showed greater improvement trends for PECF than ACDF. The complication proportion of patients with PECF was lower, while the proportion of reoperation was similar between PECF and ACDF. ACDF was the most common revision surgery. The most common complication of PECF was transient paresthesia. Conclusion: Compared with ACDF, PECF is safe and effective in patients with unilateral cervical radiculopathy without myelopathy, and PECF does not increase the probability of reoperation and complications.

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Minimally Invasive Posterior Cervical Foraminotomy as an Alternative to Anterior Cervical Discectomy and Fusion for Unilateral Cervical Radiculopathy

Cited by 52 publications

References 32 publications

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

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

Occurrence, Risk Factors, and Time Trends for Late Reoperations due to Degenerative Cervical Spine Disease: A Finnish National Register Study of 19 377 Patients Operated on Between 1999 and 2015

Percutaneous endoscopic cervical foraminotomy as a new treatment for cervical radiculopathy

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