Hostname: page-component-f554764f5-c4bhq Total loading time: 0 Render date: 2025-04-11T03:44:43.967Z Has data issue: false hasContentIssue false
  • English
  • Français

Minimally Invasive versus Open Approach for Cervical Laminoforaminotomy

Published online by Cambridge University Press:  02 December 2014

Mark J. Winder  and
Kenneth C. Thomas
Mark J. Winder*
Affiliation:
Department of Neurosurgery, St. Vincent's Hospital, Sydney, Australia Department of Neurosurgery, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
Kenneth C. Thomas
Affiliation:
Department of Orthopedic Surgery, Foothills Hospital, University of Calgary, Calgary, Alberta, Canada
*
Level 7, St Vincent's Clinic, 430 Victoria St, Darlinghurst, NSW, Australia
Rights & Permissions [Opens in a new window]

Abstract

Core share and HTML view are not available for this content. However, as you have access to this content, a full PDF is available via the ‘Save PDF’ action button.
Background:

Minimally invasive posterior cervical foraminotomy for radicular symptoms has become more prevalent. The reported experience with microscopic tubular assisted posterior cervical laminoforaminotomy (MTPF) for the treatment of radicular pain is lacking. Tubular assisted techniques have been considered to offer significant benefit, over open procedures, in terms of minimizing tissue damage, operative time, blood loss, analgesic requirements and length of hospital stay. We hypothesized that MTPF reduces post-operative analgesic requirements and length of hospital stay over the traditional open laminoforaminotomy, with no difference in complication rates and, secondly, that MTPF is comparable to endoscopic posterior foraminotomy (EPF).

Methods:

We conducted a retrospective review of 107 patients who underwent posterior cervical laminoforaminotomy for radicular pain between 1999 and 2009. Patient demographics, intra-operative parameters, length of hospitalization, post-operative analgesic use, complications and short-term neurological outcome were compared between groups.

Results:

Between 1999 and 2009, a total of 107 patients were identified to have undergone a cervical foraminotomy. An open approach was used in 65 patients, while 42 underwent MTPF. Operative time and complications were comparable between groups. Significant differences favoring MTPF were observed in operative blood loss, post-operative analgesic use and length of hospital stay (p<0.001). All results were comparable to previous reports utilizing EPF.

Conclusions:

MTPF for the treatment of cervical radiculopathy significantly reduces blood loss, post-operative analgesic use and length of hospital stay compared to the standard open approach. Operative time and complication rates were comparable between both techniques, whilst MTPF offered similar results compared to EPF.

Type
Original Article
Information
Canadian Journal of Neurological Sciences , Volume 38 , Issue 2 , March 2011 , pp. 262 - 267
Copyright
Copyright © The Canadian Journal of Neurological 2011

References

1Spurling, RG, Scoville, WB.Lateral rupture of the cervical intervertebral disc. A common cause of shoulder and arm pain. Surg Gynecol Obstet. 1944;798:350–8.Google Scholar
2Frykholm, R.Cervical root compression resulting from disc degeneration and root sleeve fibrosis. Acta Chir Scand. 1951;160:S1–149.Google Scholar
3Scoville, WB, Dohrman, GJ, Corkill, G.Late results of cervical disc surgery. J Neurosurg. 1976;45:203–10.Google Scholar
4Murphey, F, Simmons, JC, Brunson, B.Surgical treatment of laterally ruptured cervical disc. Review of 648 cases, 1939 to 1972. J Neurosurg. 1973 Jun;38(6):679–83.CrossRefGoogle ScholarPubMed
5Semmes, RE, Murphey, F.Syndrome of unilateral rupture of the sixth intervertebral disk, with compression of the seventh cervical nerve root. Report of four cases with symptoms simulating coronary disease. JAMA. 1943;121:1209–14.Google Scholar
6Robinson, R, Smith, G.Anterolateral cervical disc removal and interbody for cervical disc syndrome. Bull John Hopkins Hosp. 1955;96–223.Google Scholar
7Smith, GW, Robinson, RA.The treatment of certain cervical-spine disorders by anterior removal of the intervertebral disc and interbody fusion. J Bone Joint Surg Am. 1958 Jun;40-A(3): 607–24.Google Scholar
8Cloward, R.The anterior approach for removal of ruptured cervical discs. J Neurosurg. 1958;15:602–17.Google Scholar
9Clements, DH, O’Leary, PF.Anterior cervical discectomy and fusion. Spine (Phila Pa 1976). 1990 Oct;15(10):1023–5.Google Scholar
10Bertalanffy, H, Eggert, HR.Clinical long-term results of anterior discectomy without fusion for treatment of cervical radiculopathy and myelopathy. A follow-up of 164 cases. Acta Neurochir (Wien). 1988;90(3-4):127–35.Google Scholar
11Hilibrand, AS, Yoo, JU, Carlson, GD, Bohlman, HH.The success of anterior cervical arthrodesis adjacent to a previous fusion. Spine (Phila Pa 1976). 1997 Jul 15;22(14):1574–9.Google Scholar
12Hunter, LY, Braunstein, EM, Bailey, RW.Radiographic changes following anterior cervical fusion. Spine (Phila Pa 1976). 1980 Sep-Oct;5(5):399–401.Google Scholar
13Braunstein, EM, Hunter, LY, Bailey, RW.Long term radiographic changes following anterior cervical fusion. Clin Radiol. 1980 Mar;31(2):201–3.Google Scholar
14Wu, W, Thuomas, KA, Hedlund, R, Leszniewski, W, Vavruch, L.Degenerative changes following anterior cervical discectomy and fusion evaluated by fast spin-echo MR imaging. Acta Radiol. 1996 Sep;37(5):614–7.CrossRefGoogle ScholarPubMed
15Pospiech, J, Stolke, D, Wilke, HJ, Claes, LE.Intradiscal pressure recordings in the cervical spine. Neurosurgery. 1999 Feb;44(2):379–84; discussion 384-5.CrossRefGoogle ScholarPubMed
16Hilibrand, AS, Carlson, GD, Palumbo, MA, Jones, PK, Bohlman, HH.Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am. 1999 Apr;81(4):519–28.CrossRefGoogle Scholar
17Ishihara, H, Kanamori, M, Kawaguchi, Y, Nakamura, H, Kimura, T.Adjacent segment disease after anterior cervical interbody fusion. Spine J. 2004 Nov-Dec;4(6):624–8.Google Scholar
18Robertson, JT, Papadopoulos, SM, Traynelis, VC.Assessment of adjacent-segment disease in patients treated with cervical fusion or arthroplasty: a prospective 2-year study. J Neurosurg Spine. 2005 Dec;3(6):417–23.Google Scholar
19Yue, WM, Brodner, W, Highland, TR.Long-term results after anterior cervical discectomy and fusion with allograft and plating: a 5- to 11-year radiologic and clinical follow-up study. Spine (Phila Pa 1976). 2005 Oct 1;30(19):2138–44.Google Scholar
20Mummaneni, PV, Burkus, JK, Haid, RW, Traynelis, VC, Zdeblick, TA.Clinical and radiographic analysis of cervical disc arthroplasty compared with allograft fusion: a randomized controlled clinical trial. J Neurosurg Spine. 2007 Mar;6(3):198–209.Google Scholar
21Mummaneni, PV, Robinson, JC, Haid, RW Jr., Cervical arthroplasty with the PRESTIGE LP cervical disc. Neurosurgery. 2007 Apr;60(4 Suppl 2):310–4; discussion 314-5.Google Scholar
22Sasso, RC, Smucker, JD, Hacker, RJ, Heller, JG.Artificial disc versus fusion: a prospective, randomized study with 2-year follow-up on 99 patients. Spine (Phila Pa 1976). 2007 Dec 15;32(26):2933–40; discussion 2941-2.Google Scholar
23Sasso, RC, Smucker, JD, Hacker, RJ, Heller, JG.Clinical outcomes of BRYAN cervical disc arthroplasty: a prospective, randomized, controlled, multicenter trial with 24-month follow-up. J Spinal Disord Tech. 2007 Oct;20(7):481–91.Google Scholar
24Morpeth, JF, Williams, MF.Vocal fold paralysis after anterior cervical diskectomy and fusion. Laryngoscope. 2000 Jan;110(1):43–6.Google Scholar
25Papavero, L, Heese, O, Klotz-Regener, V, Buchalla, R, Schroder, F, Westphal, M.The impact of esophagus retraction on early dysphagia after anterior cervical surgery: does a correlation exist? Spine (Phila Pa 1976). 2007 May 1;32(10):1089–93.Google Scholar
26Jagannathan, J, Sherman, JH, Szabo, T, Shaffrey, CI, Jane, JA.The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up. J Neurosurg Spine. 2009 Apr;10(4):347–56.Google Scholar
27Clarke, MJ, Ecker, RD, Krauss, WE, McClelland, RL, Dekutoski, MB.Same-segment and adjacent-segment disease following posterior cervical foraminotomy. J Neurosurg Spine. 2007 Jan;6(1):5–9.Google Scholar
28McCormick, PC.The adjacent segment. J Neurosurg Spine. 2007 Jan;6(1):1–4; discussionGoogle Scholar
29Adamson, TE.Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg. 2001 Jul;95 Suppl 1:51–7.Google Scholar
30Coric, D, Adamson, T.Minimally invasive cervical microendoscopic laminoforaminotomy. Neurosurg Focus. 2008;25(2):E2.Google Scholar
31Epstein, NE.A review of laminoforaminotomy for the management of lateral and foraminal cervical disc herniations or spurs. Surg Neurol. 2002 Apr;57(4):226–33; discussion 233-4.Google Scholar
32Epstein, NE.Minimally invasive/endoscopic vs “open” posterior cervical laminoforaminotomy: do the risks outweigh the benefits? Surg Neurol. 2009 Mar;71(3):330–1.Google Scholar
33Parker, WD.Cervical laminoforaminotomy. J Neurosurg. 2002 Mar;96 Suppl 2:254; author reply -5.Google ScholarPubMed
34Henderson, CM, Hennessy, RG, Shuey, HM Jr., Shackelford, EG.Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. 1983 Nov;13(5):504–12.Google Scholar
35Fessler, RG, Khoo, LT.Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery. 2002 Nov;51(5 Suppl):S37–45.Google Scholar
36Ruetten, S, Komp, M, Merk, H, Godolias, G.A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients. Minim Invasive Neurosurg. 2007 Aug;50(4):219–26.Google Scholar
37Ruetten, S, Komp, M, Merk, H, Godolias, G.Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine (Phila Pa 1976). 2008 Apr 20;33(9):940–8.Google Scholar
38Kyoung-Tae, K, Young-Baeg, K.Comparison between open procedure and tubular retractor assisted procedure for cervical radiculopathy: results of a randomized controlled study. J Korean Med Sci. 2009;24:649–53.Google Scholar
39Adamson, TE.The impact of minimally invasive cervical spine surgery. Invited submission from the Joint Section Meeting on Disorders of the Spine and Peripheral Nerves, March 2004. J Neurosurg Spine. 2004 Jul;1(1):43–6.Google Scholar
40Gala, VC, O’Toole, JE, Voyadzis, JM, Fessler, RG.Posterior minimally invasive approaches for the cervical spine. Orthop Clin North Am. 2007 Jul;38(3):339–49; abstract v.Google Scholar
41Hanks, G, Cherny, N, Fallon, M.Opioid analgesic therapy. Oxford Textbook of Palliative Medicine. Oxford: Oxford University Press; 2004. p. 316–41.Google Scholar
42Shaheen, PE, Walsh, D, Lasheen, W, Davis, MP, Lagman, RL.Opioid equianalgesic tables: are they all equally dangerous? J Pain Symptom Manage. 2009 Sep;38(3):409–17.Google Scholar
43Caglar, YS, Bozkurt, M, Kahilogullari, G, et al.Keyhole approach for posterior cervical discectomy: experience on 84 patients. Minim Invasive Neurosurg. 2007 Feb;50(1):7–11.Google Scholar
44Heary, RF, Ryken, T, Matz, PG, et al.Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy. J Neurosurg Spine. 2009;11(Aug):198–202.Google Scholar
45Russell, SM, Benjamin, V.Posterior surgical approach to the cervical neural foramen for intervertebral disc disease. Neurosurgery. 2004 Mar;54(3):662–5; discussion 665-6.Google Scholar
46Shiraishi, T.A new technique for exposure of the cervical spine laminae. Technical note. J Neurosurg. 2002 Jan;96 Suppl 1: 122–6.Google Scholar