title: Feasibility of Posterior Cervical Foraminotomy in Cervical Foraminal Stenosis: Prediction of Surgical Outcomes by the Foraminal Shape on Preoperative Computed Tomography.
abstract: METHODS
  A retrospective cohort study.
  
  
  OBJECTIVE
  The aim of this study was to compare the feasibility of posterior cervical laminoforaminotomy (PCF) for V- or parallel-shaped foraminal stenosis (FS).
  
  
  BACKGROUND
  During PCF, the need for extensive facet resection would depend on the extent of any pathology. When resection is extensive, the possibilities of instability and incomplete decompression should be considered.
  
  
  METHODS
  From March 2004 to March 2015, we enrolled 36 patients following single-level PCF procedures for FS. We classified patients by foraminal shape on preoperative computed tomography (CT) scan into V-shaped and parallel-shaped groups. We then compared arm and neck pain using a numeric rating scale (NRS) and clinical outcomes using Odom criteria. Radiological evaluation included dynamic X-rays for instability and CT scans for facet resection.
  
  
  RESULTS
  We enrolled 16 and 20 patients in the V-shape and parallel-shape groups, respectively. By Odom criteria, no patient was graded fair or poor in the V group, but five patients were graded as fair and one patient as poor in the parallel group. Continued postoperative arm pain at 1 year, which was related to incomplete decompression, was significantly higher in parallel group. Only one patient complained of postoperative neck pain with an NRS >5, and another five patients sustained radiculopathy with an NRS >5. Among five patients who complained sustained radiculopathy, one patient required revision surgery for incomplete decompression. The amount of facet removal was not different significantly between groups, and no patient had postoperative instability.
  
  
  CONCLUSIONS
  Although PCF seems to be a good surgical option for V-shaped FS, we experienced worse outcomes for patients with parallel-shaped FS. We recommend that ACDF or more aggressive posterior foraminotomy be performed with fusion when presented with parallel neuroforaminal compression.
  
  
  METHODS
  4.
authors.affiliation: Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Bon Sub
authors.initials: BS
authors.lastname: Gu
authors.affiliation: Department of Neurological Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Jin Hoon
authors.initials: JH
authors.lastname: Park
authors.affiliation: Department of Neurosurgery, Bumin Hospital, Seoul, Korea.
authors.forename: Han Yu
authors.initials: HY
authors.lastname: Seong
authors.affiliation: Department of Emergency Medicine, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea.
authors.forename: Sang Ku
authors.initials: SK
authors.lastname: Jung
authors.affiliation: Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Roh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery*; D003251:Constriction, Pathologic / Q000601:surgery*; D017586:Diskectomy / Q000379:methods; D005260:Female; D059526:Foraminotomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D009333:Neck / Q000601:surgery*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects / Q000379:methods; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult