title: Minimally invasive foraminotomy through tubular retractors via a contralateral approach in patients with unilateral radiculopathy.
abstract: BACKGROUND
  Radiculopathy caused by foraminal nerve root compression is a common pathology in the lumbar spine. Surgical decompression via a conventional open foraminotomy is the treatment of choice when surgery is indicated. Minimally invasive tubular foraminotomy through a contralateral approach is a potentially effective surgical alternative.
  
  
  OBJECTIVE
  The aim of this retrospective cohort study was to evaluate the efficacy and benefits of this approach for treatment of radiculopathy.
  
  
  METHODS
  Patients with unilaterally dominant lower extremity radiculopathy, who underwent minimally invasive lumbar foraminotomy through tubular retractors via a contralateral approach between 2010 and 2012, were included. Oswestry Disability Index (ODI) and the Visual Analogue Scale (VAS) for back and leg pain were evaluated preoperatively, postoperatively, and at the latest follow-up. Functional outcome was evaluated by using the MacNab criteria.
  
  
  RESULTS
  For the total 32 patients, postoperatively there was significant improvement in the ODI (P = .006), VAS back pain (P < .001), and VAS leg pain on the pathology and the approach side (P = .004, P = .021, respectively). At follow-up of 12.3 ± 1.7 months, there was also significant improvement in the ODI (P < .001), VAS back pain (P = .001), and VAS leg pain on the pathology and the approach side (P < .001, P = .001, respectively). The functional outcome was excellent and good in 95.2%. One patient required fusion (3.1%).
  
  
  CONCLUSIONS
  A minimally invasive, facet-sparing contralateral approach is an effective technique for treatment of radiculopathy due to foraminal compression. It also allows for decompression of lumbar spinal stenosis and bilateral lateral recess decompression without the need for fusion.
authors.affiliation: *Weill Cornell Brain and Spine Center, Department of Neurological Surgery, Weill Cornell Medical College, New York-Presbyterian Hospital, New York, New York; ‡Weill Cornell Medical College, New York, New York.
authors.forename: Marjan
authors.initials: M
authors.lastname: Alimi
authors.forename: Innocent
authors.initials: I
authors.lastname: Njoku
authors.forename: Guang-Ting
authors.initials: GT
authors.lastname: Cong
authors.forename: Se Young
authors.initials: SY
authors.lastname: Pyo
authors.forename: Christoph P
authors.initials: CP
authors.lastname: Hofstetter
authors.forename: Peter
authors.initials: P
authors.lastname: Grunert
authors.forename: Roger
authors.initials: R
authors.lastname: Härtl
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000295:instrumentation / Q000379:methods; D005260:Female; D059526:Foraminotomy / Q000295:instrumentation* / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000295:instrumentation / Q000379:methods; D019635:Neurosurgical Procedures / Q000295:instrumentation* / Q000379:methods*; D010147:Pain Measurement; D011843:Radiculopathy / Q000601:surgery*; D012189:Retrospective Studies; D013130:Spinal Stenosis / Q000601:surgery; D016896:Treatment Outcome