Microendoscopic anterior cervical foraminotomy: a preliminary series of 76 cases

Abstract

Abstract Background Anterior cervical foraminotomy represents a relatively recent minimally invasive approach that can potentially preserve the intervertebral disc and thus the functional motion segment. Objective This study aims to evaluate the clinical outcome of microendoscopic anterior cervical foraminotomy (MACF) for patients with cervical unilateral radiculopathy due to single level soft disc herniation or hard disc-osteophyte complex (DOC). Methods In the period between August 2009 and March 2015, 76 consecutive patients with symptomatic unilateral cervical radiculopathy were included in this study. There were 40 left-sided cervical radiculopathy cases and 36 right-sided; of those, 42 had soft disc fragment herniation, 18 had DOC, 12 had a migrated disc fragment whether cranial or caudal, and four had far lateral (foraminal) disc herniation. In all cases, MACF with root decompression was performed. Cervical magnetic resonance imaging (MRI), computed tomography (CT) scan, and plain X-rays were performed for all patients and then repeated postoperatively. All patients were followed-up for at least a year. Clinical and functional outcomes were assessed using visual analogue scale (VAS) and Odom’s criteria. Results According to VAS score, there was an improvement in neck pain from 6.4 (range 5–10) to 1.5 (1–5) and in arm pain from 7.2 (range 6–10) to 1.2 (0–4) at final follow-up (P < 0.05). Functional outcomes according to Odom’s criteria were excellent in 59 (78%) cases, good in ten (13%), fair in six (8%), and poor in one (1%) case. Success of surgery was considered to be achieved in 91% (excellent + good) of cases. Mean operating time was 81 min, and mean intraoperative blood loss was 21 ml. Most significant complications included a dural tear in one case, transient postoperative dysesthesia in six cases, excess bony work resulting in unintended uncinectomy in three cases, fracture of transverse process in one case, unintended near total discectomy in two cases, infective discitis in one case, and persistent radicular pain due to incomplete osteophyte removal in one case. Conclusions This preliminary report suggests that MACF yields overall excellent results in selected patients with unilateral cervical radiculopathy. The technique potentially can preserve the functional motion segment, thus patients typically experience immediate postoperative neck mobility and do not need to wear a cervical collar.

Keywords

• Anterior cervical foraminotomy
• Cervical radiculopathy
• Soft disc herniation
• Microendoscopic cervical surgery