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.
AdamsonTBroomeA: Initial experience with endoscopic posterior cervical laminoforaminotomy for the treatment of cervical radiculopathyCervical Spine Research Society: 26th Annual Meeting Proceedings.Atlanta: Cervical Spine Research Society199897Cervical Spine Research Society: 26th Annual Meeting Proceedings.
BertalanffyHEggertHR: Clinical long-term results of anterior disectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases.Acta Neurochir90:127–1351988Acta Neurochir 90:
FaberCA: Management of cervical disc lesions and spondylosis by posterior approaches.Clin Neurosurg24:488–5071977Faber CA: Management of cervical disc lesions and spondylosis by posterior approaches. Clin Neurosurg 24:
FrykholmR: Cervical root compression resulting from disc degeneration and root sleeve fibrosis.Acta Chi Scand160:1–1491951Frykholm R: Cervical root compression resulting from disc degeneration and root sleeve fibrosis. Acta Chi Scand 160:
HakubaA: Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs.J Neurosurg45:284–2911976Hakuba A: Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg 45:
HendersonCHennessyRGShueyHMJret al: Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases.Neurosurgery13:504–5121983Neurosurgery 13:
JhoHD: Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation.J Neurosurg84:155–1601996Jho HD: Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg 84:
LosassoTJMuzziDADietzNMet al: Fifty percent nitrous oxide does not increase the risk of venous air embolism in neurosurgical patients operated upon in the sitting position.Anesthesiology77:21–301992Anesthesiology 77:
RaynorR: Anterior or posterior approach to the cervical spine: an anatomical and radiographic evaluation and comparison.Neurosurgery12:7–131983Raynor R: Anterior or posterior approach to the cervical spine: an anatomical and radiographic evaluation and comparison. Neurosurgery 12:
SemmesREMurphyF: Syndrome of unilateral rupture of the sixth cervical intervertebral disk, with compression of the seventh cervical nerve root. Report of four cases with symptoms simulating coronary disease.JAMA121:1209–12141943.JAMA 121:
SimpsonJSimeoneF: Surgical management of cervical disc disease: posterior approachAnHSimpsonJ (eds): Surgery of the Cervical Spine.Baltimore: Williams & Wilkins213–2261994Surgery of the Cervical Spine.
WilliamsRW: Microcervical foraminotomy. A surgical alternative for intractable radicular pain.Spine8:708–7161983Williams RW: Microcervical foraminotomy. A surgical alternative for intractable radicular pain. Spine 8: