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Eur Spine J. 2015 Dec;24(12):3005-12. doi: 10.1007/s00586-015-4198-1. Epub 2015 Aug 23.

Minimally invasive cervical foraminotomy and diskectomy for laterally located soft disk herniation.

Kim CH1,2,3, Kim KT4, Chung CK5,6,7,8, Park SB1,9, Yang SH1,2, Kim SM2, Sung JK4.

Author information

1
Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-gu, Seoul, 110-744, Republic of Korea.
2
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea.
3
Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea.
4
Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Republic of Korea.
5
Department of Neurosurgery, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-gu, Seoul, 110-744, Republic of Korea. chungc@snu.ac.kr.
6
Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea. chungc@snu.ac.kr.
7
Clinical Research Institute, Seoul National University Hospital, Seoul, Republic of Korea. chungc@snu.ac.kr.
8
Department of Brain and Cognitive Sciences, Seoul National University College of Natural Sciences, Seoul, Republic of Korea. chungc@snu.ac.kr.
9
Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea.

Abstract

PURPOSE:

The posterior cervical foraminotomy and diskectomy (PCD) is a traditional surgical technique for patients with laterally located soft-disk herniation. Recently, tubular retractor-assisted posterior foraminotomy and diskectomy (MTPF) and posterior percutaneous endoscopic cervical foraminotomy and diskectomy (P-PECD) have been introduced, but a comparative study has not yet been performed.

METHODS:

Patients with foraminal soft-disk herniation and a follow-up period of >2 years were retrospectively reviewed; 22 patients underwent a MTPF and 22 patients underwent a P-PECD. The primary end-point was an improvement of arm pain more than 4.3. The clinical parameters (age, sex, disability index, neck and arm pain), radiological parameters (cervical curvature, segmental angle, anterior-/posterior-disk height and amount of facet joint removal) preoperatively and at postoperative month 24 and the surgical methods were considered as co-variates.

RESULTS:

Successful outcome was achieved in 19/22 (87%) of the patients after both MTPF and a P-PECD. Preoperative SA showed trend (P = 0.08; OR 1.2; 95% CI 0.98-1.4) and the cut-off SA was 1.45° (sensitivity 80%, specificity 73%). The length of the facet joint's removal was 0.02-2.49 mm (0.1-15.2%) with no difference between the MTPF and P-PECD. The surgical method was not a significant factor.

CONCLUSIONS:

For patients with foraminal soft-disk herniation, either MTPF or P-PECD, may be regarded as an alternative options to open surgery. Preoperative kyphotic SA (cut-off value 1.45°) seemed to be associated with poor outcome and this may be considered in selecting surgical methods.

KEYWORDS:

Cervical vertebrae; Disk; Endoscopes; Percutaneous; Tubular retractor

PMID:
26298479
DOI:
10.1007/s00586-015-4198-1
[Indexed for MEDLINE]

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