Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy.
BACKGROUND
Posterior cervical foraminotomy (PCF) with or without microdiscectomy (posterior cervical discectomy [PCD]) is a frequently used surgical technique for cervical radiculopathy secondary to foraminal stenosis or a laterally located herniated disc. Currently, these procedures are being performed with increasing frequency using advanced minimally invasive techniques. Although the safety and efficacy of minimally invasive PCF/PCD (MI-PCF/PCD) have been established, reports on long-term outcome and need for secondary surgical intervention at the index or adjacent level are lacking.


OBJECTIVE
To determine the rates of complications, long-term outcomes, and need for secondary surgical intervention at the index or adjacent level after MI-PCF and microdiscectomy.


METHODS
Retrospective analysis of a prospective cohort.


METHODS
Seventy patients treated with MI-PCF and/or MI-PCD for cervical radiculopathy.


METHODS
Visual Analog Scale for neck/arm (VASN/A) pain and Neck Disability Index (NDI).


METHODS
Ninety-seven patients underwent MI-PCF with or without MI-PCD between 2002 and 2011. Adequate prospective follow-up was available for 70 patients (95 cervical levels). The primary outcome assessed was need for secondary surgical intervention at the index or adjacent level. The secondary outcomes assessed included complications and improvements in NDI and VASN/A scores. All complications were reviewed. Mixed-model analyses of variance with random subject effects and autoregressive first-order correlation structures were used to test for differences among NDI, VASA, and VASN measurements made over time while accounting for the correlation among repeated observations within a patient. All statistical hypothesis tests were conducted at the 5% level of significance.


RESULTS
Patients were followed for a mean of 32.1 months. Of 70 patients operated, there were 3 (4.3%) complications (1 cerebrospinal fluid leak, 1 postoperative wound hematoma, and 1 radiculitis), none of which required a secondary operative intervention. Five patients required an anterior cervical discectomy and fusion (eight total levels fused) on average 44.4 months after the index surgery. Of those, five (5.3%) were at the index level and three (2.1%) were at adjacent levels. Neck Disability Index scores improved significantly (p<.0001) immediately postoperatively and continued to decrease gradually with time. Visual Analog Scale for neck/arm scores improved significantly (p<.0001) from baseline immediately postoperatively but tended to plateau with time.


CONCLUSIONS
Minimally invasive PCF with or without MI-PCD is an excellent alternative for cervical radiculopathy secondary to foraminal stenosis or a laterally located herniated disc. There is a low rate (1.1% per index level per year) of future index site fusion and a very low rate (0.9% per adjacent level per year) of adjacent-level disease requiring surgery.
Department of Neurosurgery, Mount Sinai School of Medicine, 1 Gustave L Levy Place, Box 1136, New York, NY 10128, USA.
Branko
B
Skovrlj
Department of Neurosurgery, Mount Sinai School of Medicine, 1 Gustave L Levy Place, Box 1136, New York, NY 10128, USA.
Yakov
Y
Gologorsky
Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 2210, Chicago, IL 60611, USA.
Raqeeb
R
Haque
Department of Neurosurgery, Northwestern University Feinberg School of Medicine, 676 N St Clair St, Suite 2210, Chicago, IL 60611, USA.
Richard G
RG
Fessler
Department of Orthopedic Surgery, Mount Sinai School of Medicine, 5 E. 98th St, Box 1188, New York, NY 10128, USA. Electronic address: sheeraz.qureshi@mountsinai.org.
Sheeraz A
SA
Qureshi
D000328:Adult; D002574:Cervical Vertebrae / Q000601:surgery*; D015331:Cohort Studies; D004185:Disability Evaluation; D017586:Diskectomy / Q000009:adverse effects / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D059526:Foraminotomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D010147:Pain Measurement; D011183:Postoperative Complications; D011446:Prospective Studies; D011843:Radiculopathy / Q000601:surgery*; D012086:Reoperation; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000706:statistics & numerical data*; D016896:Treatment Outcome
Adjacent-level disease; Anterior cervical fusion; Complications; Microdiscectomy; Outcome scores; Posterior cervical foraminotomy