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

Restricted access

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

  • View in gallery

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

  • View in gallery

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

  • View in gallery

    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.

  • View in gallery

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

References

1.

Adamson TBroome A: 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.

2.

Aldrich F: Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg 72:3703771990Aldrich F: Posterolateral microdiscectomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg 72:

3.

Baba GFurusawa NImura Set al: Late radiographic findings after anterior cervical fusion for spondylotic myeloradiculopathy. Spine 18:216721731993Spine 18:

4.

Bertalanffy HEggert HR: Clinical long-term results of anterior disectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir 90:1271351988Acta Neurochir 90:

5.

Bulger RFRejowskiJEBeattyRA: Vocal cord paralysis associated with anterior cervical fusion: considerations for prevention and treatment. J Neurosurg 62:6576611985J Neurosurg 62:

6.

Clements DHO'Leary PF: Anterior cervical discectomy and fusion. Spine 15:102310251990.Spine 15:

7.

Cloward R: The anterior approach for removal of ruptured cervical discs. J Neurosurg 15:6026171958Cloward R: The anterior approach for removal of ruptured cervical discs. J Neurosurg 15:

8.

Connolly ESeymour RAdams J: Clinical evaluation of anterior cervical fusion for degenerative cervical disease. J Neurosurg 23:4314371965J Neurosurg 23:

9.

DePalma AFRothman RHLewinnek GEet al: Anterior interbody fusion for severe cervical disc degeneration. Surg Gynecol Obstet 134:7557581972Surg Gynecol Obstet 134:

10.

Ducker TBZeidman SM: The posterior operative approach for cervical radiculopathy. Neurosurg Clin North Am 4:61741993Neurosurg Clin North Am 4:

11.

Ebersold MJRaynor RBBoris GKet al: Cervical laminotomy, laminectomy, labioplasty, and foraminotomyBenzel EC (ed): New York: Churchill Livingston 1999249255

12.

Faber CA: Management of cervical disc lesions and spondylosis by posterior approaches. Clin Neurosurg 24:4885071977Faber CA: Management of cervical disc lesions and spondylosis by posterior approaches. Clin Neurosurg 24:

13.

Fischgrund JHerkowitz H: Anterior surgical procedures for cervical disc diseaseAn HSimpson J (eds): Surgery of the Cervical Spine. Baltimore: Williams & Wilkins1994195212Surgery of the Cervical Spine.

14.

Flynn TB: Neurologic complication of anterior cervical interbody fusion. Spine 7:5365391982Flynn TB: Neurologic complication of anterior cervical interbody fusion. Spine 7:

15.

Frykholm R: Cervical root compression resulting from disc degeneration and root sleeve fibrosis. Acta Chi Scand 160:11491951Frykholm R: Cervical root compression resulting from disc degeneration and root sleeve fibrosis. Acta Chi Scand 160:

16.

Gore DRSepic SB: Anterior cervical fusion for degenerated or protruded discs: a review of 146 patients. Spine 9:6676711984Spine 9:

17.

Hakuba A: Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg 45:2842911976Hakuba A: Trans-unco-discal approach. A combined anterior and lateral approach to cervical discs. J Neurosurg 45:

18.

Hankinson HWilson C: Use of the operating microscope in anterior cervical discectomy and fusion. J Neurosurg 43:4524561975J Neurosurg 43:

19.

Henderson CHennessy RGShuey HM Jret al: Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery 13:5045121983Neurosurgery 13:

20.

Herkowitz HNKurz LTOverholt DP: Surgical management of cervical soft disc herniation. A comparison between the anterior and posterior approach. Spine 15:102610301990Spine 15:

21.

Hilibrand ASYoo JUCarlson GDet al: The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine 22:157415791997Spine 22:

22.

Hunter LYBraunstein EMBailey RR: Radiographic changes following anterior cervical fusion. Spine 5:3994011980Spine 5:

23.

Jho HD: Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg 84:1551601996Jho HD: Microsurgical anterior cervical foraminotomy for radiculopathy: a new approach to cervical disc herniation. J Neurosurg 84:

24.

Krupp WSchattke HMuke R: Clinical results of the foraminotomy as described by Frykholm for the treatment of lateral cervical disc herniation. Acta Neurochir 107:22291990Acta Neurochir 107:

25.

Lang J: Clinical Anatomy of the Cervical Spine. New York: George Thieme Verlag1993124126Lang J: Clinical Anatomy of the Cervical Spine.

26.

Losasso TJMuzzi DADietz NMet al: Fifty percent nitrous oxide does not increase the risk of venous air embolism in neurosurgical patients operated upon in the sitting position. Anesthesiology 77:21301992Anesthesiology 77:

27.

Lunsford LDBissonette JDJannetta PJet al: Anterior surgery for cervical disc disease. Part 1: treatment of lateral cervical disc herniation in 253 cases. J Neurosurg 53:1111980J Neurosurg 53:

28.

Murphey FSimmons JCBrunson B: Surgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939 to 1972. J Neurosurg 38:6796831973J Neurosurg 38:

29.

Newhouse KELindsey RWClark CR: Esophageal perforation following anterior cervical spine surgery. Spine 14:105110531989Spine 14:

30.

Odom GLFinney WWoodhall B: Cervical disc lesions. JAMA 166:23281958JAMA 166:

31.

Pospiech JStolke DWilke HJet al: Intradiscal pressure recordings in the cervical spine. Neurosurgery 44:3793851999Neurosurgery 44:

32.

Raynor R: Anterior or posterior approach to the cervical spine: an anatomical and radiographic evaluation and comparison. Neurosurgery 12:7131983Raynor R: Anterior or posterior approach to the cervical spine: an anatomical and radiographic evaluation and comparison. Neurosurgery 12:

33.

Raynor RBPugh JShapiro I: Cervical facetectomy and its effect on spine strength. J Neurosurg 63:2782821985J Neurosurg 63:

34.

Robinson RASmith GW: Anterolateral cervical disc removaland interbody for cervical disc syndrome. Bull John Hopkins Hospital 96:2231955Bull John Hopkins Hospital 96:

35.

Robinson RAWalker AFerlic Det al: The results of anterior interbody fusion of the cervical spine. J Bone Joint Surg (Am) 44:156915871962J Bone Joint Surg (Am) 44:

36.

Scoville WBDohrmann GJCorkill G: Late results of cervical disc surgery. J Neurosurg 45:2032101976J Neurosurg 45:

37.

Semmes REMurphy F: 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. JAMA 121:120912141943.JAMA 121:

38.

Simeone FDillin W: Treatment of cervical disc disease: selection of operative approach. Contemp Neurosurg 8:161986Contemp Neurosurg 8:

39.

Simpson JSimeone F: Surgical management of cervical disc disease: posterior approachAn HSimpson J (eds): Surgery of the Cervical Spine. Baltimore: Williams & Wilkins2132261994Surgery of the Cervical Spine.

40.

Smith GRobinson R: The treatment of certain cervical spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg (Am) 42:6076231958J Bone Joint Surg (Am) 42:

41.

Smith MFoley K: Microendoscopic discectomy. Tech Neurosurg 3:3013071997Tech Neurosurg 3:

42.

Sonntag VKHKlara P: Controversy in spine care. Is fusion necessary after anterior cervical discectomy? Spine 21:111111131996Spine 21:

43.

Spurling RGScoville WB: Lateral rupture of the cervical intervertebral disc. A common cause of shoulder and arm pain. Surg Gynecol Obstet 798:3503581944Surg Gynecol Obstet 798:

44.

Verbiest H: A lateral approach to the cervical spine: technique and indications. J Neurosurg 28:1912031968Verbiest H: A lateral approach to the cervical spine: technique and indications. J Neurosurg 28:

45.

Watters WC IIILevinthal R: Anterior cervical discectomy with and without fusion. Results, complications and long-term follow-up. Spine 19:234323471994Spine 19:

46.

Williams RW: Microcervical foraminotomy. A surgical alternative for intractable radicular pain. Spine 8:7087161983Williams RW: Microcervical foraminotomy. A surgical alternative for intractable radicular pain. Spine 8:

47.

Woertgen CHolzschuh MRothoerl RDet al: Prognostic factors of posterior cervical disc surgery: a prospective, consecutive study of 54 patients. Neurosurgery 40:7247291997Neurosurgery 40:

48.

Wu WThuomas KHedlund Ret al: Degenerative changes following anterior cervical disectomy and fusion evaluated by fast spin-echo MR imaging. Acta Radiol 37:6146171996Acta Radiol 37:

49.

Zdeblick TAZou DWarden KEet al: Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg (Am) 72:22271992J Bone Joint Surg (Am) 72:

50.

Zeidman SMDucker TB: Posterior cervical laminoforaminotomy for radiculopathy: review of 172 cases. Neurosurgery 33:3563621993Neurosurgery 33:

TrendMD

Metrics

Metrics

All Time Past Year Past 30 Days
Abstract Views 6 6 6
Full Text Views 17 17 10
PDF Downloads 80 80 41
EPUB Downloads 0 0 0

PubMed

Google Scholar