J Korean Med Sci.  2009 Aug;24(4):649-653. 10.3346/jkms.2009.24.4.649.

Comparison Between Open Procedure and Tubular Retractor Assisted Procedure for Cervical Radiculopathy: Results of a Randomized Controlled Study

• Kim KT
• Kim YB

• KMID: 1779198
• DOI: http://doi.org/10.3346/jkms.2009.24.4.649

Abstract

Posterior cervical foraminotomy is an effective surgical technique for the treatment of radicular pain caused by foraminal stenosis or posterolateral herniated discs. The present study was performed to compare the clinical parameters and surgical outcomes of open foraminotomy/discectomy (OF/OFD) and tubular retractor assisted foraminotomy/discectomy (TAF/TAFD) in the treatment of cervical radiculopathy. A total of 41 patients were divided into two groups: 19 patients in Group 1 underwent OF/OFD and 22 patients in Group 2 underwent TAF/TAFD. Among the various clinical parameters, skin incision size, length of hospital stay, analgesic using time, and postoperative neck pain (for the first 4 weeks after the operation) were favorable in Group 2. Surgical outcomes were not different between the two groups. In conclusion, TAF/TAFD should increase patient's compliance and is as clinically effective as much as the OF/OFD.

Keyword

Radiculopathy; Microendoscopic Foraminotomy; Open Foraminotomy

MeSH Terms

Adult
Aged
Analgesics/therapeutic use
Cervical Vertebrae/*surgery
Diskectomy
Female
Humans
Length of Stay
Male
Middle Aged
Pain Measurement
Radiculopathy/*surgery/therapy
Surgical Procedures, Minimally Invasive
Tomography, X-Ray Computed
Treatment Outcome

Figure

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  Fig. 1 Postoperative CT shows the foramintomy defect. (A) Transverse diameter (B) Vertical diameter.

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  Fig. 2 The K-wire is advanced slowly through the musculature under fluoroscopic guidance and docked on bone at the inferomedial edge of the rostral lateral mass at the target level.

Reference

1. Henderson CM, Hennessy RG, Shuey HM Jr, Shackelford EG. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983. 13:504–512.

2. Caglar YS, Bozkurt M, Kahilogullari G, Tuna H, Bakir A, Torun F, Ugur HC. Keyhole approach for posterior cervical discectomy: experience on 84 patients. Minim Invasive Neurosurg. 2007. 50:7–11.

3. Ducker TB, Zeidman SM. The posterior operative approach for cervical radiculopathy. Neurosurg Clin N Am. 1993. 4:61–74.

4. Semmes RE, Murphey 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. 1943. 121:1209–1214.

5. Murphey F, Simmons JC, Brunson B. Surgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939 to 1972. J Neurosurg. 1973. 38:679–683.

6. Aldrich F. Posterolateral microdisec tomy for cervical monoradiculopathy caused by posterolateral soft cervical disc sequestration. J Neurosurg. 1990. 72:370–377.

7. Korinth MC, Kruger A, Oertel MF, Gilsbach JM. Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease: results in 292 patients with monoradiculopathy. Spine. 2006. 31:1207–1214.

8. Jodicke A, Daentzer D, Kastner S, Asamoto S, Boker DK. Risk factors for outcome and complications of dorsal foraminotomy in cervical disc herniation. Surg Neurol. 2003. 60:124–129.

9. Onimus M, Destrumelle N, Gangloff S. Surgical treatment of cervical disk displacement. Anterior or posterior approach? Rev Chir Orthop Reparatrice Appar Mot. 1995. 81:296–301.

10. Fessler RG, Khoo LT. Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery. 2002. 51:S37–S45.

11. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? Spine J. 2004. 4:190S–194S.

12. Ishihara H, Kanamori M, Kawaguchi Y, Nakamura H, Kimura T. Adjacent segment disease after anterior cervical interbody fusion. Spine J. 2004. 4:624–628.

13. Odom GL, Finney W, Woodhall B. Cervical disk lesions. JAMA. 1958. 166:23–28.

14. Roh SW, Kim DH, Cardoso AC, Fessler RG. Endoscopic foraminotomy using MED system in cadaveric specimens. Spine. 2000. 25:260–264.

15. O'Toole JE, Sheikh H, Eichholz KM, Fessler RG, Perez-Cruet MJ. Endoscopic posterior cervical foraminotomy and discectomy. Neurosurg Clin N Am. 2006. 17:411–422.

16. Zeidman SM, Ducker TB. Posterior cervical laminoforaminotomy for radiculopathy: review of 172 cases. Neurosurgery. 1993. 33:356–362.

17. Krupp W, Schattke H, Muke R. Clinical results of the foraminotomy as described by Frykholm for the treatment of lateral cervical disc herniation. Acta Neurochir (Wien). 1990. 107:22–29.

18. Parker WD. Cervical laminoforaminotomy. J Neurosurg. 2002. 96:254.

19. Gala VC, O'Toole JE, Voyadzis JM, Fessler RG. Posterior minimally invasive approaches for the cervical spine. Orthop Clin N Am. 2007. 38:339–349.

20. Foley KT, Smith MM. Microendoscopic discectomy. Tech Neurosurg. 1997. 3:301–307.

21. Shin DA, Kim KN, Shin HC, Yoon DH. The efficacy of microendoscopic discectomy in reducing iatrogenic muscle injury. J Neurosurg Spine. 2008. 8:39–43.