Clinical Outcomes of Single-level Posterior Percutaneous Endoscopic Cervical Foraminotomy for Patients with Less Cervical Lordosis

Abstract

Objective Posterior percutaneous endoscopic cervical foraminotomy (P-PECF) is a minimally invasive surgical technique for treatment of cervical radiculopathies. Application of P-PECF to patients with preexisting loss of cervical curvature (<10°) is still controversial because violation to facet joint may lead to kyphotic change. Clinical outcomes of P-PECF was analyzed and compared according to preoperative cervical curvature. Methods In this retrospective nested case-control study, 71 patients who underwent P-PECF due to foraminal soft disc herniation or bony stenosis were reviewed. P-PECF was performed by a single senior surgeon, and surgical methods were as previously described. Visual analogue pain scale on arm (Arm-VAS) was assessed preoperatively and postoperatively (1, 3, 6, 12 month and yearly thereafter). All patients were clinically followed for 24.5±20.0 months. The minimal clinically important difference of the Arm-VAS was set at 2.5. Patients with preoperative cervical curvature ≥10° were included in group I (n=32) and cervical curvature <10° or kyphosis were included in the group II (n=39). Results At the last follow up, 68/71 (96%) patients showed significant reduction of arm pain (Pre-operation, 7.4±2.0; post-operation, 1.5±2.0) after 1.74±0.29 months (95% CI; 1.18-2.31). The preoperative cervical curvature did not influence the outcome (p=0.4, T-test) and time to reach the clinical endpoint (p=0.34, Cox-logistic regression analysis). Conclusion P-PECF effectively reduced radicular pain due to foraminal soft disc herniation or stenosis. Preexisting loss of lordosis is not a risk factor for outcomes of P-PECF.

Keywords

• cervical
• endoscope
• kyphosis
• outcome
• pain
• spine
• surgery