title: Minimally Invasive Posterior Cervical Foraminotomy: Freiburg Experience With 34 Patients.
abstract: METHODS
  Retrospective cohort study.
  
  
  OBJECTIVE
  Assessment of outcome after minimally invasive posterior cervical foraminotomy (MI-PCF).
  
  
  BACKGROUND
  Surgical management of cervical radiculopathy represents a controversial area in spinal surgery. Preferred approaches include both anterior cervical discectomy and posterior cervical foraminotomy (PCF). Numerous studies showed comparable results. Employing PCF eliminates risks associated with anterior approach. PCF as originally described by Spurling and Scoville necessitates extensive stripping of cervical muscles to expose the cervical spine, resulting in muscle injury, impaired muscle function, prolonged postoperative neck pain, and increased use of narcotics. There are only few studies investigating outcome after employing MI-PCF.
  
  
  METHODS
  Retrospective review of 34 patients who underwent MI-PCF for presenting complaints, postoperative and follow-up outcome.
  
  
  RESULTS
  In the last follow-up the weakness resolved completely in 62.6% of patients, in 4.1% improved and in 16.5% remained unchanged. In the last follow-up 76.7% of patients originally presenting with pain reported complete resolution of pain and 10% reported partial improvement of pain. In total, 23.5% of patients were lost during follow-up as far as pain was concerned. In the last follow-up, 75% of patients achieved relative neck-pain-freedom (Visual Analog Scale≤3) at rest and 62.5% of patients under strain. The mean neck pain on Visual Analog Scale at rest was 2.13 (SD=2.42) and 3.34 (SD=3.01) under strain. In total, 93.8% (n=15) of patients would undergo the same procedure for the same achieved result.
  
  
  CONCLUSIONS
  Minimally invasive cervical foraminotomy is an effective procedure for decompression of cervical nerve roots regardless the type of the stenosis. Even employing minimally invasive technique still causes neck pain in the long term affecting up to 25% of patients. More randomized control studies are required to clarify the benefits of minimally invasive PCF.
authors.affiliation: Department of Neurosurgery, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany.
authors.forename: Ivo
authors.initials: I
authors.lastname: Peto
authors.forename: Christian
authors.initials: C
authors.lastname: Scheiwe
authors.forename: Evangelos
authors.initials: E
authors.lastname: Kogias
authors.forename: Ulrich
authors.initials: U
authors.lastname: Hubbe
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D059526:Foraminotomy / Q000295:instrumentation / Q000379:methods*; D005858:Germany; D006801:Humans; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000379:methods*; D011843:Radiculopathy / Q000601:surgery*; D012189:Retrospective Studies; D015898:Tomography Scanners, X-Ray Computed; D064232:Visual Analog Scale