J Korean Neurosurg Soc.  2017 Jul;60(4):433-440. 10.3340/jkns.2015.0909.006.

Preservation of Motion at the Surgical Level after Minimally Invasive Posterior Cervical Foraminotomy

• Lee YS
• Kim YB
• Park SW
• Kang DH

• KMID: 2387881
• DOI: http://doi.org/10.3340/jkns.2015.0909.006

Abstract

OBJECTIVE
Although minimally invasive posterior cervical foraminotomy (MI-PCF) is an established approach for motion preservation, the outcomes are variable among patients. The objective of this study was to identify significant factors that influence motion preservation after MI-PCF.
METHODS
Forty-eight patients who had undergone MI-PCF between 2004 and 2012 on a total of 70 levels were studied. Cervical parameters measured using plain radiography included C2-7 plumb line, C2-7 Cobb angle, T1 slope, thoracic outlet angle, neck tilt, and disc height before and 24 months after surgery. The ratios of the remaining facet joints after MI-PCF were calculated postoperatively using computed tomography. Changes in the distance between interspinous processes (DISP) and the segmental angle (SA) before and after surgery were also measured. We determined successful motion preservation with changes in DISP of ≤3 mm and in SA of ≤2°.
RESULTS
The differences in preoperative and postoperative DISP and SA after MI-PCF were 0.03±3.95 mm and 0.34±4.46°, respectively, fulfilling the criteria for successful motion preservation. However, the appropriate level of motion preservation is achieved in cases in which changes in preoperative and postoperative DISP and SA motions are 55.7 and 57.1%, respectively. Based on preoperative and postoperative DISP, patients were divided into three groups, and the characteristics of each group were compared. Among these, the only statistically significant factor in motion preservation was preoperative disc height (Pearson's correlation coefficient=0.658, p<0.001). The optimal disc height for motion preservation in regard to DISP ranges from 4.18 to 7.08 mm.
CONCLUSION
MI-PCF is a widely accepted approach for motion preservation, although desirable radiographic outcomes were only achieved in approximately half of the patients who had undergone the procedure. Since disc height appears to be a significant factor in motion preservation, surgeons should consider disc height before performing MI-PCF.

Keyword

Minimally invasive posterior cervical foraminotomy; Motion change; Motion preservation; Disc height

MeSH Terms

Foraminotomy*
Humans
Neck
Radiography
Surgeons
Zygapophyseal Joint

Figure

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  Fig. 1 Cervical parameters used to evaluate kyphotic change and motion preservation.

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  Fig. 2 Postoperative computed tomography shows the remnant of facet joint (A/B).

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  Fig. 3 Correlation between pre-postoperative motion change and disc heights. Correlation coefficient (r) is 0.658 for pre-postoperative distance between interspinous processes (A) (p<0.001) and 0.258 for pre-postoperative segmental angle (B) (p=0.017).

Reference

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