J Korean Neurosurg Soc.  2016 Jul;59(4):374-378. 10.3340/jkns.2016.59.4.374.

Long-Term Outcome of Posterior Cervical Inclinatory Foraminotomy

• Heo J
• Chang JC
• Park HK

• KMID: 2315973
• DOI: http://doi.org/10.3340/jkns.2016.59.4.374

Abstract

OBJECTIVE
A modified surgical technique of posterior cervical foramintomy called posterior cervical inclinatory foraminotomy (PCIF) was introduced in previous preliminary article. PCIF allows better preservation of facet joint and capsule than conventional techniques. The authors conducted a study to investigate long-term outcomes of PCIF.
METHODS
We retrospectively reviewed demographic, radiologic, and clinical data from the patients who underwent PCIFs at our institution. Criteria included a minimum of 48 month follow-up and PCIFs for patients with radiculopathy from foraminal stenosis (C2-T1; single or multilevel) with persistent or recurrent root symptoms despite conservative treatment for more than 3 months. Patients who had undergone previous cervical operation were excluded. The visual analogue scale (VAS) score was used for clinical follow-up, and radiologic follow-up was performed to compare the changes of cervical sagittal alignment, focal angle and disc-space height of treated segment.
RESULTS
The PCIFs were performed between April 2007 and March 2011 on 46 patients (32 males and 14 females) with a total of 73 levels affected. The average duration of follow-up was 74.4 months. Improvements in radiculopathic pain were seen in 39 patients (84.7%), and VAS score decreased from 6.82±1.9 to 2.19±1.9. Posterior neck pain also improved in 25 patients (71.4%) among 35 patients, and VAS score decreased from 4.97±2.0 to 2.71±1.9. The mean disc-space heights of treated segment were 5.41±1.03 mm preoperatively and decreased to 5.17±1.12 mm postoperatively. No statistically significant changes in cervical sagittal alignment, focal angle were seen during the follow-up period (Cox proportional hazards analysis and Student t-test, p>0.05).
CONCLUSION
The PCIF is highly effective in treating patients with cervical spondylotic radiculopathy, leading to long-lasting relief in pain. Long-term radiologic follow-up showed no significant spinal angular imbalance.

Keyword

Cervical; Posterior; Foraminotomy; Cervical spondylosis; Radiculopathy

MeSH Terms

Constriction, Pathologic
Follow-Up Studies
Foraminotomy*
Humans
Male
Neck Pain
Radiculopathy
Retrospective Studies
Spondylosis
Zygapophyseal Joint

Figure

• 

  Fig. 1 Box and whisker plot of clinical outcomes measure by visual analogue scale (VAS). Radiculopathy and neck pain improved rapidly in early postoperative period, and maintained afterward. Box represents the first and third quartile, line inside box is median. *Outlier, more or less than interquartile range.

• 

  Fig. 2 Box and whisker plot of disc height index (DHI). DHI is calculated as disc-space height divided by preoperative height at treated level. DHI decreased statistically during the follow-up period (p<0.05). Box represents the first and third quartile, line inside box is median. *Outlier, more or less than interquartile range.

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