J Korean Neurosurg Soc.  2020 Nov;63(6):767-776. 10.3340/jkns.2020.0033.

Feasibility of Posterior Cervical Foraminotomy for Adjacent Segmental Disease after Anterior Cervical Fusion

• Kim HJ
• Kang MS
• Lee SH
• Park CH
• Chung SW
• Shin YH
• Lee SY
• Park ES

• KMID: 2508607
• DOI: http://doi.org/10.3340/jkns.2020.0033

Abstract

Objective
: The aim of this study is to evaluate the feasibility of posterior cervical foraminotomy (PCF) for adjacent segmental disease (ASD) after anterior cervical fusion (ACF). As ACF is accepted as the standard treatment for cervical spondylosis, many studies have been conducted to evaluate the efficacy of various surgical techniques to overcome symptomatic ASD after the previous surgery. Herein, PCF was performed for the treatment of symptomatic ASD and the feasibility of the surgery was evaluated.
Methods
: Forty nine patients who underwent PCF due to symptomatic ASD from August 2008 to November 2017 were identified. For demographic and perioperative data, the sex, age, types of previous surgery, ASD levels, operation times, and bleeding amount were recorded. The clinical outcome was assessed using the visual analogue scale for the neck and arm, the modified Odom’s criteria as well as neck disability index. Radiologic evaluations were performed by measuring disc softness, disc height, the cervical 2–7 sagittal vertical axis, cervical cobb angle, and facet violation.
Results
: Thirty-seven patients were enrolled in this study. The patients were divided into two groups based on the location of the pathology; paracentral (group P) or foramina (group F). Both groups showed significant clinical improvement (p<0.05). The proportion of calcified disc and facet violations was significantly larger in group F (p<0.05). The minimal disc height decrease with mild improvement on sagittal alignment and cervical lordosis was radiologically measured without statistical significance in both groups (p>0.05).
Conclusion
: PCF showed satisfactory clinical and radiologic outcomes for both paracentral and foraminal pathologies of ASD after ACF. Complications related to anterior revision were also avoided. PCF can be considered a feasible and safe surgical option for ASD after ACF.

Keyword

Minimaly invasive surgery; Revision surgery; Foraminotomy; Radiculopathy

Figure

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  Fig. 1. A : The white line is the midline of the facet joint. Pathology across this line was categorized as paracentral while that outside the line was categorized as foraminal. B : Double headed arrow indicates the disc height. It was measured as the length from the midpoint of the upper endplate of the lower vertebral body to the midpoint of the lower endplate of the upper vertebral body. C : The C2–7 sagittal vertical axis (SVA) was measured as the length from the vertical line starting at the center of the C2 vertebral body (vertical black line) to the end point of the superior posterior of the C7 vertebral body (horizontal black line). The cervical Cobb angle (CA) was measured as the angle between two lines parallel to the lower margin of the C2 vertebral body and the upper margin of the C7 vertebral body (white lines). D : The amount of facet resection was measured as the proportion of resected facet (A, white line) compared to the original facet (B, white line). The formula was (A–B) / A × 100.

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  Fig. 2. A : Disc height change with time shows a minimal decrease after posterior cervical foraminotomy (PCF). B : C2–7 sagittal vertical axis change with time shows the improvement of the sagittal alignment after PCF. C : Cervical Cobb angle with time shows mild recovery of cervical lordosis after PCF. Pre-op : preoperation, Post-op : postoperation, f/u : follow up.

Reference

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