title: A Transtubular Microsurgical Approach to Treat Lateral Cervical Disc Herniation.
abstract: OBJECTIVE
  Different surgical options are available to treat radicular pain syndromes of the cervical spine. Use of the posterior approach for foraminotomy and sequestrectomy (Frykholm) fusion can be avoided, but neck pain affects the postoperative course. This retrospective study compares the classical Frykholm approach and the transtubular microsurgical approach for foraminotomy.
  
  
  METHODS
  From 2004 to 2012, 40 patients fulfilled the inclusion criteria and were enrolled into this retrospective study. The classical Frykholm approach was performed on 25 affected levels. The transtubular microsurgical approach was used on 19 affected levels. Endpoints were neck pain, radicular pain, surgery time, duration of hospital stay, and long-term outcomes.
  
  
  RESULTS
  For the transtubular microsurgical approach and the classical Frykholm approach, the mean surgery time was 77.65 ± 23 minutes and 104 ± 27.59 minutes (P = 0.003), respectively. Radicular pain improved in all patients regardless of the technical approach. Significant differences were observed in neck pain on the first postoperative day (P = 0.003) and at discharge (P = 0.006), resulting in a shorter hospital stay of 4.82 days ± 2.1 for the transtubular microsurgical approach in comparison with 7.43 days ± 3.2 for the Frykholm approach (P = 0.005). According to the criteria of Odom, the rate of an excellent or good outcome was 97.5% (67.5% excellent and 30% good), without any differences between the compared approaches.
  
  
  CONCLUSIONS
  The transtubular microsurgical approach shows advantages regarding postoperative neck pain, surgery time, and hospital stay with a trend towards an earlier return to work.
authors.affiliation: Department of Neurosurgery, University Medical Center, Hamburg-Eppendorf, Germany; Department of Neurosurgery, HHU University Hospital, Düsseldorf, Germany. Electronic address: eicker.s@mac.com.
authors.forename: Sven Oliver
authors.initials: SO
authors.lastname: Eicker
authors.affiliation: Department of Neurosurgery, HHU University Hospital, Düsseldorf, Germany.
authors.forename: Hans Jakob
authors.initials: HJ
authors.lastname: Steiger
authors.affiliation: Department of Neurosurgery, HHU University Hospital, Düsseldorf, Germany.
authors.forename: Mustafa
authors.initials: M
authors.lastname: El-Kathib
mesh_terms: D000328:Adult; D000368:Aged; D015984:Causality; D002574:Cervical Vertebrae / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D059526:Foraminotomy / Q000379:methods / Q000706:statistics & numerical data; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D007902:Length of Stay / Q000706:statistics & numerical data; D008137:Longitudinal Studies; D008297:Male; D008866:Microsurgery / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D061646:Operative Time; D010149:Postoperative Pain / Q000453:epidemiology* / Q000517:prevention & control; D015995:Prevalence; D011843:Radiculopathy / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Cervical disc herniation; Foraminotomy; Minimally invasive; Radiculopathy; Transtubular microsurgical approach