Surgical Outcome of Posterior Cervical Foramenotomy
Objective: Objective of the study was to evaluate the surgical outcome of posterior foraminotomy in patients with cervical spondylotic radicular symptoms.
Material and Methods: This descriptive observational study was conducted at the department of neurosurgery lady reading hospital Peshawar from July 2012 to June 2018 (6 years). The author has personal experience of 29 patients during the study period. All consecutive patients who underwent posterior cervical foraminotomy for cervical spondylotic radiculopathy included in the study, irrespective of their age and gender. After approval from the hospital ethical committee, informed consent was taken from patients or their relatives. The patients were followed up improvement of symptoms and post-operative complications. The data was entered in a specially designed Performa. Patients’ data was analyzed using SPSS version 21.
Results: We had total 29 patients during the study period who full fill the inclusion criteria. Most (65.5%) of our patients were men. Age of the patients ranged from 23-66 years with the mean age of 44.5% year. The most common level involved was C6-7 (41.4%) followed by C5-6 (37.9%). The most common operative indications for cervical radiculopathy was lateral soft disc herniation followed by osteophyte formation and foraminal stenosis. Post operatively arm pain relieved in almost all patients. Pins and needles, improved in 79.3% cases. Post-operatively neck pain and superficial wound infection was observed each in one (3.4%) case. One of our patients improved initially, but after 2 months had recurrent of symptoms and needed anterior cervical discectomy.
Conclusion: We conclude from our study that cervical spondylotic radiculopathy patients respond well to posterior cervical foraminotomy. This procedure is having an acceptable complication rate. This is an effective and safe procedure. This approach can be an alternative treatment choice in patients with cervical radiculopathy secondary to lateral disc herniation, and or foraminal stenosis.
2 Chang JC, park HK, choi SK. Posterior cervical inclinatory foramenotomy for spondylotic radiculopathy preliminary. J Korean Neurosurg soc. 2011; 49 (5): 308-313.
3. Tumialan LM, Ponton RP, Gulf WM. Management of unilateral cervical radiculopathy, in the military. Cost effectiveness of posterior cervical foramenotomy compared with anterior cervical discectomy and fusion. Neurosurg focus, 2010; 28: E17.
4. Thomas C, Leheta O, Krauss JK, zevgaridis D. A prospective randomized comparison of rectangular titanium cage fusion and iliac crest autograft fusion in patients undergoing anterior cervical discectomy. J Neurosurg Spine, 2006; 4: 1-9.
5. Church EW, Halpen CH, Faught RW, Balmuri U, Attrah MA, Hayden S ET al. cervical laminoforamenotomy and functional outcome in a large cohort and a long term followup. Surg neuro lint. 2014; 30 (15): 536-43.
6. Cloward RB. The anterior approach for removal of ruptured cervical discs 1958. J Neurosurg spine, 2007; 6: 496-511.
7. Chang JC, Park HK, Bea PJ. Monomeric measurement of the anatomical land mark in anterior cervical microforamenotomy. J Korea Neurosurg Soc. 2006; 39: 340-46.
8. Hilton DL. Minimally invasive tubular accesss for posterior cervical foramenotomy with three-dimentional miscroscopic visualization and localization with anterior/posterior imaging. Spine J. 2007: 7: 154-158.
9. Cho TG, Kim YB, Park SW. long term effect on adjacent segment motion after posterior cervical foramenotomy. Korean J Spine, 2014; 11: 1-6.
10. Choi JH, Kim JS, Lee SH. Cervical spinal epidural hematoma following cervical posterior lamenoforamenotomy. J Korean Neurosurg Soc. 2013; 53: 125-28.
11. Escoglu M, Yilmaz, Karalar M, Aydin MD, Kayaci S, Gundogdu C et al. The role of sympathectomy on the regulation of basilar artery volume changes in sterio-occlusive carotid artery modeling after bilateral common carotid artery ligation on animal model. Acta Neurochir (Wien). 2014; 156: 963-9.
12. Fehlings MG, Gray RJ. Posterior cervical foramenotomy for the treatment of cervical radiculopathy. J Neurosurg spine, 2009; 10: 343-344.
13. Scoville WB, Dohrmann GJ, corkill G. late results of cervical disc surgery. J Neurosurg. 1976; 45: 203-210.
14. Gala VC, Otoole Je, voyadzis JM, Fessler RG. Posterior minimally invasive approach for cervical spine. OrthopClin North Am. 2007; 38: 339-349.
15. Youlas C, Ozdemir NG, Kahraman U, Okey HO, Kanat A, Senol M et al. cervical disc herniation through posterior laminoforamenotomy. J Cranio-vertebral Junction Spine, 2016; 7 (2): 91-95.
16. Grieve JP, kitchen ND, Moore AJ, Marsh HT. results of posterior cervical foramenotomy for the treatment of cervical spondylotic radiculopathy. Br J Neurosurg. 2000; 14: 40-43.
17. Schoggl A, Reddy M, Saringer W, ungersbock. Social and economic outcome after posterior microforamenotomy for cervical spondylotic radiculopathy. Wein kiln wochenschr. 2002; 144: 200-204.
18. Dohrmann GJ, Hsieh JC. Long term results of anterior versus posterior operations for herniated cervical discs. Analysis of 6000 patients. Med princ pract. 2014; 23: 70-73.
19. Skovrij B, Gologorskey Y, Haque R, Fessler RG, Qureshi SA. Complications, outcomes and need for fusion after minimally invasive posterior cervical foramenotomy and microdiscectomy. Spine J. 2014; 14: 2405-11.
20. Yang JS, Chu L, Chen L, Chen F, Ke ZU, Deng ZL. Anterior or posterior approach of full endoscopic cervical discectomy for cervical intervertebral disc herniation. A comparative cohort study. Spine (phila pa 1976). 2014; 39: 1743-50.
21. Clark MJ, fecker RD, krauss WE, McCleunad RL, dekutoski MB. Same segment and adjacent segment disease following posterior cervical foramenotomy. J Neurosurg Spine, 2007; 6: 5-9.
22. Zdeblick, TA, Zou D, warden KE, McCabe R, Kunz D, vanderby R. cervical stability after foramenotomy, a biomeckanical invitro analysis. J Bone Joint Surg Am. 1992; 74: 22-27.
23. Ratliff JK, cooper PR. Cervical laminoplasty; a crtical review. J Neurosurg. 2003; 98: 230-238.
24. Bydon M, Mathios D, Macki M, Ramos RDLG, Sciubba DM, Wimam TF, Wolinsky PW, Gokaslan ZL, Bydon A. long term patient outcome after posterior cervical foramenotomy; analysis of 151 cases. J Neurosurg Spine, 2014; 21 (5): 727-731.
25. Punjabi MM, white AA, Jhonson RM. Cervical spine mechanics as a function of transection of components. J Biomech 1975; 8: 327-336.
26. Ulrich C, woersdoerfer O, Kaiff R, Claes L, Wilke HJ. Biomechanics of fixation systems to the cervical spine. Spine (phila pa 1976). 1991; 16: 54-59.
27. Brigham CD, Tsahakis PJ. Anterior cervical foramenotomy and fusion ; segmental techniques and results. Spine (phila pa 1976). 1995; 20: 766.
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