title: Clinical and radiological long-term outcomes of anterior microforaminotomy for cervical degenerative disease.
abstract: METHODS
  A retrospective review.
  
  
  OBJECTIVE
  To evaluate the long-term clinical and radiological results after anterior microforaminotomy (AMF), with details of postoperative degeneration.
  
  
  BACKGROUND
  AMF is an alternative procedure to treat unilateral cervical radiculopathy. Although previous clinical results are favorable, degeneration may occur after surgery. However, the details of this have not been proven.
  
  
  METHODS
  A total of 154 AMF procedures in 135 patients were performed. Of these, 82 patients (97 AMF) had complete preoperative and minimum 3-year postoperative clinical outcomes data available for analysis. Radiological data were analyzed with picture achieving communication system images. Long-term clinical results were accessed by a questionnaire and telephone interviews. Clinical and radiological parameters were statistically analyzed.
  
  
  RESULTS
  Spondylosis comprised 53.7%, disc herniation comprised 36%, and mixed comprised 10.3%. The mean age was 49 (range, 31-76) years. Operated levels were 1 level in 71 patients, 2 in 10, and 3 in 1. Reoperation was performed in 2 patients (2.4%). The mean follow-up was 6.1 years. A total of 90.3% achieved an excellent or good outcome. Visual analogue scale scores improved from 8.2 (6-10) to 2.9 (0-10), and neck disability index scores improved from 24.5 (7-46) to 6.7 (0-31) (P < 0.05). Eighty-one cases (83.5%) showed a decrease in disc height (DH), with 1 mm of the mean. The DH decrease was positively correlated with disc invasion (P < 0.01) and AMF diameter (P < 0.01). According to statistical analysis, the critical AMF diameter was 4.7 mm. Anterior spur formation occurred in 39 cases (40.2%). No radiological parameters affected the clinical outcome.
  
  
  CONCLUSIONS
  AMF is a safe, effective procedure to treat unilateral cervical radiculopathy. Critical DH decreases may be the trigger of sequential degeneration. To preserve DH, disc invasion must be avoided, and AMF must be made as small as possible with exact removal of compressive lesion.
  
  
  METHODS
  4.
authors.affiliation: From the Department of Neurosurgery, School of Medicine, Ewha Womans University, Mok-dong, Yangcheon-gu, Seoul, South Korea.
authors.forename: Myung-Hyun
authors.initials: MH
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D019299:Decompression, Surgical / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000000981:diagnostic imaging; D008297:Male; D008866:Microsurgery / Q000379:methods*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods*; D011843:Radiculopathy / Q000000981:diagnostic imaging / Q000601:surgery*; D011859:Radiography; D015203:Reproducibility of Results; D012189:Retrospective Studies; D055009:Spondylosis / Q000000981:diagnostic imaging / Q000601:surgery; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome