Minimally invasive cervical foraminotomy and diskectomy for laterally located soft disk herniation
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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.
KeywordsCervical 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).
This study was approved by the institutional review board at the Seoul National University Hospital (H-1210- 078-434).
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