Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases

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Object. In this report the author presents surgery-related outcomes after application of a new technique. A posterior microendoscopic laminoforaminotomy was used for the surgical treatment of unilateral cervical radiculopathy secondary to intervertebral disc herniations and/or spondylotic foraminal stenosis. The results of this procedure are compared with those achieved using traditional laminoforaminotomy and anterior cervical discectomy with or without fusion.

Methods. One hundred consecutive patients who experienced unilateral cervical radicular syndromes, which were refractory to conservative therapy, and in whom imaging studies had confirmed lateral canal or foraminal compression, underwent surgical treatment. An endoscopy-assisted posterior laminoforaminotomy was performed using a microendoscopic visualization system for removal of herniated disc and foraminal decompression while the patient was in the sitting position.

Excellent or good results were obtained in 97 patients, who returned to their preoperative employment and baseline level of physical activity. One patient returned to work but was unable to perform at baseline level; two patients returned to prior sedentary work but continued to have some activity-related pain and paresthesias. Two patients reported experiencing intermittent paresthesias or numbness, but this did not limit their activities. There were two cases of dural punctures, one case of superficial wound infection, and no deaths.

Conclusions. The microendoscopic posterior laminoforaminotomy is an effective alternative for the treatment of unilateral cervical radiculopathy secondary to lateral or foraminal disc herniations or spondylosis. In this group of patients, it is preferable because it does not require the sacrifice of a cervical motion segment, has a low incidence of complications, and is associated with a much quicker return to unrestricted full activity than that obtained with other techniques.

Article Information

Address reprint requests to: Tim E. Adamson, M.D., Carolina Neurosurgery and Spine Associates, 1010 Edgehill Road North, Charlotte, North Carolina 28207. email: TimAdamson@CNSA.com.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Fluoroscopic images depicting sequence of steps in dilator and retractor placement.

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    Photograph showing the operative system, including microendoscope, in place.

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    Artist's depiction of the surgical exposure for laminoforaminotomy. Note the relation of foraminotomy to the superior pedicle. Soft-disc herniation can be observed in the axilla of the nerve root.

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    Bar graph showing return to work/full activity in 100 postoperative patients.

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