title: Minimally invasive tubular access for posterior cervical foraminotomy.
abstract: BACKGROUND
  Minimally invasive tubular access for posterior cervical foraminotomy can be an effective and safe technique for decompression of the nerve root utilizing minimally invasive muscle splitting with routine outpatient discharge. This technique has come under scrutiny calling into question the associated learning curve, a subjective limited exposure provided, and an argument that the risks and complications are largely unknown. In response to previously published critiques, this study aims to describe the outcomes and complications associated with this technique in a large patient series.
  
  
  METHODS
  A retrospective chart review was performed from 1999 to 2013 capturing a single surgeon's experience with the minimally invasive tubular access for posterior cervical foraminotomy technique from a single institution, encompassing 463 patients. Surgical outcome documented at follow-up and complications were obtained from this patient series. Additional variables analyzed include: Hospital length of stay, number of levels operated, targeted root for decompression, side operated, length of surgery, and estimated blood loss.
  
  
  RESULTS
  Outpatient discharge was achieved in 91.6% of cases. There were 10 complications (2.2%) among the 463 patients undergoing this technique from 1999 to 2013. Patients were followed for an average of 1 year and 2 months postoperatively. Improvement from the preoperative condition was observed in 98.2% of patients and excellent outcomes with patients reporting complete relief of symptoms with no or mild residual discomfort was seen in 92.2%.
  
  
  CONCLUSIONS
  Compared with open techniques, minimally invasive tubular access for posterior cervical foraminotomy demonstrates comparable, if not superior, complication rates, and patient outcomes.
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas, USA.
authors.forename: Byron C
authors.initials: BC
authors.lastname: Branch
authors.affiliation: Department of Neurosurgery, University of Texas Health Science Center, San Antonio, Texas, USA ; Department of Neurosurgery, Neurosurgical Associates of San Antonio PA, San Antonio, Texas, USA.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Hilton
authors.affiliation: Department of Neurosurgery, Neurosurgical Associates of San Antonio PA, San Antonio, Texas, USA ; Department of Neurosurgery, University of Texas School of Law, Austin, Texas, USA.
authors.forename: Clark
authors.initials: C
authors.lastname: Watts
keywords: Cervical; complications; foraminotomy; minimally invasive surgery; outcomes; tubular retractor