European Spine Journal

, Volume 24, Issue 12, pp 3005–3012 | Cite as

Minimally invasive cervical foraminotomy and diskectomy for laterally located soft disk herniation

  • Chi Heon Kim
  • Kyoung-Tae Kim
  • Chun Kee ChungEmail author
  • Sung Bae Park
  • Seung Heon Yang
  • Sung Mi Kim
  • Joo-Kyung Sung
Original Article



The posterior cervical foraminotomy and diskectomy (PCD) is a traditional surgical technique for patients with laterally located soft-disk herniation. Recently, tubular retractor-assisted posterior foraminotomy and diskectomy (MTPF) and posterior percutaneous endoscopic cervical foraminotomy and diskectomy (P-PECD) have been introduced, but a comparative study has not yet been performed.


Patients with foraminal soft-disk herniation and a follow-up period of >2 years were retrospectively reviewed; 22 patients underwent a MTPF and 22 patients underwent a P-PECD. The primary end-point was an improvement of arm pain more than 4.3. The clinical parameters (age, sex, disability index, neck and arm pain), radiological parameters (cervical curvature, segmental angle, anterior-/posterior-disk height and amount of facet joint removal) preoperatively and at postoperative month 24 and the surgical methods were considered as co-variates.


Successful outcome was achieved in 19/22 (87 %) of the patients after both MTPF and a P-PECD. Preoperative SA showed trend (P = 0.08; OR 1.2; 95 % CI 0.98–1.4) and the cut-off SA was 1.45° (sensitivity 80 %, specificity 73 %). The length of the facet joint’s removal was 0.02–2.49 mm (0.1–15.2 %) with no difference between the MTPF and P-PECD. The surgical method was not a significant factor.


For patients with foraminal soft-disk herniation, either MTPF or P-PECD, may be regarded as an alternative options to open surgery. Preoperative kyphotic SA (cut-off value 1.45°) seemed to be associated with poor outcome and this may be considered in selecting surgical methods.


Cervical vertebrae Disk Percutaneous Tubular retractor Endoscopes 


Compliance with ethical standards

Conflicts of interest

The first author (CHK) is a consultant of Richard Wolf GmbH. CKC and SBP are users of the endoscopic equipment of Richard Wolf GmbH. The other authors declares no conflict of interest concerning the materials or methods used in this study or the findings described in this paper.

Source of funding

CKC: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP) (No. 2010-0028631). CHK: This work was supported by Health Connect research fund (0620140720).

Ethical approval

This study was approved by the institutional review board at the Seoul National University Hospital (H-1210- 078-434).


  1. 1.
    Richards O, Choi D, Timothy J (2012) Cervical arthroplasty: the beginning, the middle, the end? Br J Neurosurg 26:2–6CrossRefPubMedGoogle Scholar
  2. 2.
    Park SB, Kim KJ, Jin YJ, Kim HJ, Jahng TA, Chung CK (2015) X-ray based kinematic analysis of cervical spine according to prosthesis designs: analysis of the Mobi C, Bryan, PCM, and Prestige LP. J Spinal Disord Tech 28(5):E291–E297CrossRefPubMedGoogle Scholar
  3. 3.
    Lee SE, Chung CK, Jahng TA (2012) Early development and progression of heterotopic ossification in cervical total disc replacement. J Neurosurg Spine 16:31–36CrossRefPubMedGoogle Scholar
  4. 4.
    Cho SK, Riew KD (2013) Adjacent segment disease following cervical spine surgery. J Am Acad Orthop Surg 21:3–11CrossRefPubMedGoogle Scholar
  5. 5.
    Yi S, Lim JH, Choi KS, Sheen YC, Park HK, Jang IT, Yoon do H (2009) Comparison of anterior cervical foraminotomy vs arthroplasty for unilateral cervical radiculopathy. Surg Neurol 71:677–680CrossRefPubMedGoogle Scholar
  6. 6.
    O’Toole JE, Sheikh H, Eichholz KM, Fessler RG, Perez-Cruet MJ (2006) Endoscopic posterior cervical foraminotomy and discectomy. Neurosurg Clin N Am 17:411–422CrossRefPubMedGoogle Scholar
  7. 7.
    Ruetten S, Komp M, Merk H, Godolias G (2007) A new full-endoscopic technique for cervical posterior foraminotomy in the treatment of lateral disc herniations using 6.9-mm endoscopes: prospective 2-year results of 87 patients. Minim Invasive Neurosurg 50:219–226CrossRefPubMedGoogle Scholar
  8. 8.
    Ahn Y, Lee SH, Shin SW (2005) Percutaneous endoscopic cervical discectomy: clinical outcome and radiographic changes. Photomed Laser Surg 23:362–368CrossRefPubMedGoogle Scholar
  9. 9.
    Kang MS, Choi KC, Lee CD, Shin YH, Hur SM, Lee SH (2014) Effective cervical decompression by posterior cervical foraminotomy without discectomy. J Spinal Disord Tech 27(5):271–276CrossRefPubMedGoogle Scholar
  10. 10.
    Winder MJ, Thomas KC (2011) Minimally invasive versus open approach for cervical laminoforaminotomy. Can J Neurol Sci 38:262–267CrossRefPubMedGoogle Scholar
  11. 11.
    Franzini A, Messina G, Ferroli P, Broggi G (2011) Minimally invasive disc preserving surgery in cervical radiculopathies: the posterior microscopic and endoscopic approach. Acta Neurochir Suppl 108:197–201CrossRefPubMedGoogle Scholar
  12. 12.
    Skovrlj B, Gologorsky Y, Haque R, Fessler RG, Qureshi SA (2014) Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy. Spine J 14:2405–2411CrossRefPubMedGoogle Scholar
  13. 13.
    Bydon M, Mathios D, Macki M, de la Garza-Ramos R, Sciubba DM, Witham TF, Wolinsky JP, Gokaslan ZL, Bydon A (2014) Long-term patient outcomes after posterior cervical foraminotomy: an analysis of 151 cases. J Neurosurg Spine 21:727–731CrossRefPubMedGoogle Scholar
  14. 14.
    Riew KD, Cheng I, Pimenta L, Taylor B (2007) Posterior cervical spine surgery for radiculopathy. Neurosurgery 60:S57–S63CrossRefPubMedGoogle Scholar
  15. 15.
    Fehlings MG, Gray RJ (2009) Posterior cervical foraminotomy for the treatment of cervical radiculopathy. J Neurosurg Spine 10:343–344 (author reply 344–346) CrossRefPubMedGoogle Scholar
  16. 16.
    Kim KT, Kim YB (2009) Comparison between open procedure and tubular retractor assisted procedure for cervical radiculopathy: results of a randomized controlled study. J Korean Med Sci 24:649–653PubMedCentralCrossRefPubMedGoogle Scholar
  17. 17.
    Wang TY, Lubelski D, Abdullah KG, Steinmetz MP, Benzel EC, Mroz TE (2015) Rates of anterior cervical discectomy and fusion after initial posterior cervical foraminotomy. Spine J 15:971–976CrossRefPubMedGoogle Scholar
  18. 18.
    Heary RF, Ryken TC, Matz PG, Anderson PA, Groff MW, Holly LT, Kaiser MG, Mummaneni PV, Choudhri TF, Vresilovic EJ, Resnick DK, Joint Section on Disorders of the S, Peripheral Nerves of the American Association of Neurological S, Congress of Neurological S (2009) Cervical laminoforaminotomy for the treatment of cervical degenerative radiculopathy. J Neurosurg Spine 11:198–202CrossRefPubMedGoogle Scholar
  19. 19.
    Yang JS, Chu L, Chen L, Chen F, Ke ZY, Deng ZL (2014) Anterior or posterior approach of full-endoscopic cervical discectomy for cervical intervertebral disc herniation? A comparative cohort study. Spine (Phila Pa 1976) 39:1743–1750CrossRefGoogle Scholar
  20. 20.
    Ahn Y, Moon KS, Kang BU, Hur SM, Kim JD (2012) Laser-assisted posterior cervical foraminotomy and discectomy for lateral and foraminal cervical disc herniation. Photomed Laser Surg 30:510–515CrossRefPubMedGoogle Scholar
  21. 21.
    Kim CH, Chung CK, Kim HJ, Jahng TA, Kim DG (2009) Early outcome of posterior cervical endoscopic discectomy: an alternative treatment choice for physically/socially active patients. J Korean Med Sci 24:302–306PubMedCentralCrossRefPubMedGoogle Scholar
  22. 22.
    Ruetten S, Komp M, Merk H, Godolias G (2008) Full-endoscopic cervical posterior foraminotomy for the operation of lateral disc herniations using 5.9-mm endoscopes: a prospective, randomized, controlled study. Spine (Phila Pa 1976) 33:940–948CrossRefGoogle Scholar
  23. 23.
    Kim CH, Shin KH, Chung CK, Park SB, Kim JH (2015) Changes in cervical sagittal alignment after single-level posterior percutaneous endoscopic cervical diskectomy. Global Spine J 5:31–38PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Pfirrmann CW, Metzdorf A, Zanetti M, Hodler J, Boos N (2001) Magnetic resonance classification of lumbar intervertebral disc degeneration. Spine (Phila Pa 1976) 26:1873–1878CrossRefGoogle Scholar
  25. 25.
    Lee H, Nicholson LL, Adams RD, Maher CG, Halaki M, Bae SS (2006) Development and psychometric testing of Korean language versions of 4 neck pain and disability questionnaires. Spine (Phila Pa 1976) 31:1841–1845CrossRefGoogle Scholar
  26. 26.
    Pool JJ, Ostelo RW, Hoving JL, Bouter LM, de Vet HC (2007) Minimal clinically important change of the neck disability index and the numerical rating scale for patients with neck pain. Spine (Phila Pa 1976) 32:3047–3051CrossRefGoogle Scholar
  27. 27.
    Caglar YS, Bozkurt M, Kahilogullari G, Tuna H, Bakir A, Torun F, Ugur HC (2007) Keyhole approach for posterior cervical discectomy: experience on 84 patients. Minim Invasive Neurosurg 50:7–11CrossRefPubMedGoogle Scholar
  28. 28.
    Kim CH, Chung CK, Hahn S (2013) Autologous iliac bone graft with anterior plating is advantageous over the stand-alone cage for segmental lordosis in single-level cervical disc disease. Neurosurgery 72:257–265CrossRefPubMedGoogle Scholar
  29. 29.
    Kim CH, Chung CK, Jahng TA, Park SB, Sohn S, Lee S (2015) Segmental kyphosis after cervical interbody fusion with stand-alone polyetheretherketone (PEEK) cages: a comparative study on 2 different PEEK cages. J Spinal Disord Tech 28:E17–E24CrossRefPubMedGoogle Scholar
  30. 30.
    Kang MS, Choi KC, Lee CD, Shin YH, Hur SM, Lee SH (2014) Effective cervical decompression by the posterior cervical foraminotomy without discectomy. J Spinal Disord Tech 27:271–276CrossRefPubMedGoogle Scholar
  31. 31.
    Adamson TE (2001) Microendoscopic posterior cervical laminoforaminotomy for unilateral radiculopathy: results of a new technique in 100 cases. J Neurosurg 95:51–57CrossRefPubMedGoogle Scholar
  32. 32.
    Fessler RG, Khoo LT (2002) Minimally invasive cervical microendoscopic foraminotomy: an initial clinical experience. Neurosurgery 51:S37–S45PubMedGoogle Scholar
  33. 33.
    Roh SW, Kim DH, Cardoso AC, Fessler RG (2000) Endoscopic foraminotomy using MED system in cadaveric specimens. Spine (Phila Pa 1976) 25:260–264CrossRefGoogle Scholar
  34. 34.
    Barakat M, Hussein Y (2012) Anatomical study of the cervical nerve roots for posterior foraminotomy: cadaveric study. Eur Spine J 21:1383–1388PubMedCentralCrossRefPubMedGoogle Scholar
  35. 35.
    Hwang JC, Bae HG, Cho SW, Cho SJ, Park HK, Chang JC (2010) Morphometric study of the nerve roots around the lateral mass for posterior foraminotomy. J Korean Neurosurg Soc 47:358–364PubMedCentralCrossRefPubMedGoogle Scholar
  36. 36.
    Zdeblick TA, Zou D, Warden KE, McCabe R, Kunz D, Vanderby R (1992) Cervical stability after foraminotomy. A biomechanical in vitro analysis. J Bone Joint Surg Am 74:22–27PubMedGoogle Scholar
  37. 37.
    Kim CH, Chung CK, Sohn S, Lee S, Park SB (2014) The surgical outcome and the surgical strategy of percutaneous endoscopic discectomy for recurrent disk herniation. J Spinal Disord Tech 27:415–422CrossRefPubMedGoogle Scholar
  38. 38.
    Kim CH, Chung CK, Woo JW (2012) Surgical outcome of percutaneous endoscopic interlaminar lumbar discectomy for highly migrated disc herniation. J Spinal Disord Tech (epub ahead of print) Google Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2015

Authors and Affiliations

  • Chi Heon Kim
    • 1
    • 2
    • 3
  • Kyoung-Tae Kim
    • 4
  • Chun Kee Chung
    • 1
    • 2
    • 3
    • 5
    Email author
  • Sung Bae Park
    • 1
    • 6
  • Seung Heon Yang
    • 1
    • 2
  • Sung Mi Kim
    • 2
  • Joo-Kyung Sung
    • 4
  1. 1.Department of NeurosurgerySeoul National University College of MedicineSeoulRepublic of Korea
  2. 2.Department of NeurosurgerySeoul National University HospitalSeoulRepublic of Korea
  3. 3.Clinical Research InstituteSeoul National University HospitalSeoulRepublic of Korea
  4. 4.Department of NeurosurgeryKyungpook National University HospitalDaeguRepublic of Korea
  5. 5.Department of Brain and Cognitive SciencesSeoul National University College of Natural SciencesSeoulRepublic of Korea
  6. 6.Department of NeurosurgerySeoul National University Boramae HospitalSeoulRepublic of Korea

Personalised recommendations