Interdisciplinary Neurosurgery (Dec 2021)
Cervical foraminotomy by full-endoscopic posterior cervical approach: A randomized study
Abstract
Background: FEPCP for lateral disc herniation or osteophytes is becoming a valuable technique. In 2008, the first study describing full-endoscopy posterior cervical foraminotomy (FEPCF) to treat lateral disc herniations was published. The technique has gained popularity over the last decade, and the outcomes have been compared to open or minimally invasive techniques, proving to be similarly effective. Later in 2016, FEPCF was also applied for bony foraminal stenosis. We randomized a sample of patients with cervical radiculopathy to either FEPCF or open posterior cervical foraminotomy (OPCF) to compare postoperative outcomes and foraminal size parameters. Methods: we prospectively collected data from 37 patients with cervical radiculopathy consequent to foraminal stenosis due to lateral disc herniation or osteophytes formation, failed conservative treatment, and adequate imaging (pre and postoperative three-dimensional 1 mm thick slices computer tomography (CT)). Patients were randomly assigned to FEPCF (17) or OPCF (20). Data were collected on demographics, arm and neck pain, disability, complications, and follow-up time. Foraminal size analysis was performed manually using 3D-Slicer software. The clinical outcomes and foramen dimension data were subsequently compared between the two groups. Results: There were no statistical differences in intraoperative parameters and postoperative outcomes in terms of mean postoperative arm VAS (p-value: 0.709) and mean NDI values (p-value:0.925), but postoperative mean neck pain values were lower in FEPCF patients (3.6 vs. 6.1 for OPCF, p-value:<0.001). In the FEPCF group, foraminal height, width, and area were increased by a mean value of 17.2%, 22.5%, and 19%, respectively, with no differences between FEPCF and OPCF. Conclusions: FEPCF has overlapping results in postoperative findings and foraminal size enlargement than OPCF, either for lateral disc protrusion or foraminal osteophytes.
