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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 Chung
  • Sung Bae Park
  • Seung Heon Yang
  • Sung Mi Kim
  • Joo-Kyung Sung
Original Article

Abstract

Purpose

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.

Methods

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.

Results

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.

Conclusions

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.

Keywords

Cervical vertebrae Disk Percutaneous Tubular retractor Endoscopes 

Notes

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).

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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
  • 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

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