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Erschienen in: Operative Orthopädie und Traumatologie 1/2018

19.09.2017 | Operative Techniken

Minimally invasive posterior cervical foraminotomy for treatment of radiculopathy

An effective, time-tested, and cost-efficient motion-preservation technique

verfasst von: Prof. Dr. L. Papavero, R. Kothe

Erschienen in: Operative Orthopädie und Traumatologie | Ausgabe 1/2018

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Abstract

Objective

To relieve foraminal root impingement due to lateral soft disc fragments, bony spurs, or other rarer causes.

Indications

Soft disc fragment whose bulk is >2/3 lateral to the lateral border of the thecal sac. Intraforaminal dorsal bony narrowing of the root canal. Intraforaminal synovial cyst, extra/intradural tumor.

Contraindications

Paramedian and median soft/hard disc protrusions. Kyphosis of the index level.

Surgical technique

Patient prone in reverse Trendelenburg position with the head fixed in a Mayfield clamp. Cervical spine horizontal and approximately 10 cm above the heart. Microscope from skin to skin. Skin incision: 25 mm, about 10 mm off the midline. Microsurgical blunt splitting of the muscle layers along the fiber direction. An expandable tubular retractor or a miniaturized speculum counter retractor, table anchored, is centered on the target lamino-facet junction as confirmed by fluoroscopy. Drilling of the keyhole. The axilla of the root is exposed while preserving most of the facet complex. Epidural exploration until an extruded or subligamentous disc fragment(s) is removed. If needed, removal of the dorsal bone overlying the root exiting in the foramen. The adequacy of decompression is assessed by palpating the root along its course with a small nerve hook. Closure by layers. No drain.

Postoperative management

Same day mobilization. No external brace.

Results

Minimally invasive posterior cervical foraminotomy (MI-PCF) was used to treat 103 patients for unilateral cervical radiculopathy. Mean follow-up was 32 months. Despite 1 cerebrospinal fluid leak, 1 wound hematoma, and 1 radiculitis during the early postoperative period, no patients required revision surgery. Visual analog scale (VAS) scores for neck/shoulder and arm improved significantly in the early postoperative period (3 months) and were maintained with time (p < 0.001). Neck Disability Index (NDI) improved significantly postoperatively but worsened slightly during follow-up (p < 0.001). Anterior decompression and fusion (ACDF) was required at the index level by 3 patients (mean: 55 months later) and at the adjacent level by 4 patients (mean: 27 months later).
Literatur
1.
Zurück zum Zitat Adamson TE (2001) Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg 95(1 Suppl):51–57PubMed Adamson TE (2001) Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg 95(1 Suppl):51–57PubMed
2.
Zurück zum Zitat Fessler RG et al (2002) Minimally invasive cervical microendoscopic foraminotomy; an initial clinical experience. Neurosurgery 51(5 Suppl):37–45 Fessler RG et al (2002) Minimally invasive cervical microendoscopic foraminotomy; an initial clinical experience. Neurosurgery 51(5 Suppl):37–45
3.
Zurück zum Zitat Kwon YJ (2014) Long-term clinical and radiologic outcomes of minimally invasive posterior cervical foraminotomy. J Korean Neurosurg Soc 56(3):224–229CrossRefPubMedPubMedCentral Kwon YJ (2014) Long-term clinical and radiologic outcomes of minimally invasive posterior cervical foraminotomy. J Korean Neurosurg Soc 56(3):224–229CrossRefPubMedPubMedCentral
4.
Zurück zum Zitat Mansfield HE et al (2014) Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis. Neurosurg Focus 37(5):E9. doi:10.3171/2014.8.FOCUS14373 CrossRefPubMed Mansfield HE et al (2014) Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis. Neurosurg Focus 37(5):E9. doi:10.​3171/​2014.​8.​FOCUS14373 CrossRefPubMed
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Zurück zum Zitat Skovrlj B et al (2014) Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J 14(10):2405–2411CrossRefPubMed Skovrlj B et al (2014) Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J 14(10):2405–2411CrossRefPubMed
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Zurück zum Zitat Zdeblick TA et al (1993) Cervical stability after sequential capsule resection. Spine 18(14):2005–2008CrossRefPubMed Zdeblick TA et al (1993) Cervical stability after sequential capsule resection. Spine 18(14):2005–2008CrossRefPubMed
Metadaten
Titel
Minimally invasive posterior cervical foraminotomy for treatment of radiculopathy
An effective, time-tested, and cost-efficient motion-preservation technique
verfasst von
Prof. Dr. L. Papavero
R. Kothe
Publikationsdatum
19.09.2017
Verlag
Springer Medizin
Erschienen in
Operative Orthopädie und Traumatologie / Ausgabe 1/2018
Print ISSN: 0934-6694
Elektronische ISSN: 1439-0981
DOI
https://doi.org/10.1007/s00064-017-0516-6

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