Acta Neurochirurgica

, Volume 159, Issue 12, pp 2369–2377 | Cite as

Clinical and radiological results of posterior cervical foraminotomy at two or three levels: a 3-year follow-up

Original Article - Spine



Single-level unilateral posterior cervical foraminotomy is regarded as a safe method. However, the outcomes of posterior cervical foraminotomy performed on two or three levels are uncertain and debated. We aimed to analyze the long-term clinical and radiological outcomes of posterior cervical foraminotomy at two or three levels.


From September 2008 to December 2011, a total of 42 patients who underwent a posterior cervical foraminotomy at two or three levels and were followed for at least 3 years were analyzed with retrospective cohort study. Clinical assessments were performed using the visual analog scale (VAS), neck disability index (NDI) and modified MacNab criteria. Radiological evaluation included the assessment of static and dynamic lateral radiographs to identify instability, postlaminectomy kyphotic deformity, adjacent segmental degeneration (ASD), and focal degeneration.


The mean VAS improved from preoperative score 8.5 ± 0.3 to postoperative score 1.8 ± 0.5 significantly. The mean presenting NDI score was 32.9 ± 2.0 and the mean postoperative NDI score was 14.2 ± 1.3. Improvement of radiculopathy was displayed in 39 patients (92.9%). During radiological evaluation, no significant change in disc height related to ASD and focal degeneration was noted. However, we confirmed one patient with radiological instability and one patient with radiological postlaminectomy kyphotic deformity.


Posterior cervical foraminotomy at two or three levels is fairly effective for treating patients with cervical radiculopathy, and results in long-lasting pain relief and improved quality of life in nearly all patients. However, further studies of three levels that include more patients are needed.


Posterior foraminotomy Cervical Foraminotomy Multilevel 


Compliance with ethical standards

Conflict of interest


Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of formal consent is not required.

Informed consent

Informed consent was obtained from all individual participants included in the study. Additional informed consent was obtained from all individual participants for whom identifying information is included in this article.


  1. 1.
    Albert TJ, Vacarro A (1998) Postlaminectomy kyphosis. Spine (Phila Pa 1976) 23:2738–2745CrossRefGoogle Scholar
  2. 2.
    Baba H, Chen Q, Uchida K, Imura S, Morikawa S, Tomita K (1996) Laminoplasty with foraminotomy for coexisting cervical myelopathy and unilateral radiculopathy: a preliminary report. Spine (Phila Pa 1976) 21:196–202CrossRefGoogle Scholar
  3. 3.
    Bogduk N (2003) The anatomy and pathophysiology of neck pain. Phys Med Rehabil Clin N Am 14:455–472 v CrossRefPubMedGoogle Scholar
  4. 4.
    Bush K, Hillier S (1996) Outcome of cervical radiculopathy treated with periradicular/epidural corticosteroid injections: a prospective study with independent clinical review. Eur Spine J 5:319–325CrossRefPubMedGoogle Scholar
  5. 5.
    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
  6. 6.
    Carette S, Fehlings MG (2005) Clinical practice. Cervical radiculopathy. N Engl J Med 353:392–399CrossRefPubMedGoogle Scholar
  7. 7.
    Cicala RS, Thoni K, Angel JJ (1989) Long-term results of cervical epidural steroid injections. Clin J Pain 5:143–145CrossRefPubMedGoogle Scholar
  8. 8.
    Clarke MJ, Ecker RD, Krauss WE, McClelland RL, Dekutoski MB (2007) Same-segment and adjacent-segment disease following posterior cervical foraminotomy. J Neurosurg Spine 6:5–9CrossRefPubMedGoogle Scholar
  9. 9.
    Cloward RB (1958) The anterior approach for removal of ruptured cervical disks. J Neurosurg 15:602–617CrossRefPubMedGoogle Scholar
  10. 10.
    Fouyas IP, Statham PF, Sandercock PA (2002) Cochrane review on the role of surgery in cervical spondylotic radiculomyelopathy. Spine (Phila Pa 1976) 27:736–747CrossRefGoogle Scholar
  11. 11.
    Henderson CM, Hennessy RG, Shuey HM Jr, Shackelford EG (1983) Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery 13:504–512CrossRefPubMedGoogle Scholar
  12. 12.
    Heo J, Chang JC, Park HK (2016) Long-term outcome of posterior cervical inclinatory foraminotomy. J Korean Neurosurg Soc 59:374–378CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Hilibrand AS, Carlson GD, Palumbo MA, Jones PK, Bohlman HH (1999) Radiculopathy and myelopathy at segments adjacent to the site of a previous anterior cervical arthrodesis. J Bone Joint Surg Am 81:519–528CrossRefPubMedGoogle Scholar
  14. 14.
    Jagannathan J, Sherman JH, Szabo T, Shaffrey CI, Jane JA (2009) The posterior cervical foraminotomy in the treatment of cervical disc/osteophyte disease: a single-surgeon experience with a minimum of 5 years’ clinical and radiographic follow-up. J Neurosurg Spine 10:347–356CrossRefPubMedGoogle Scholar
  15. 15.
    Joaquim AF, Riew KD (2017) Multilevel cervical arthroplasty: current evidence. A systematic review. Neurosurg Focus 42:E4CrossRefPubMedGoogle Scholar
  16. 16.
    Korinth MC, Kruger A, Oertel MF, Gilsbach JM (2006) Posterior foraminotomy or anterior discectomy with polymethyl methacrylate interbody stabilization for cervical soft disc disease: results in 292 patients with monoradiculopathy. Spine 31:1207–1214. discussion 1215-1206 CrossRefPubMedGoogle Scholar
  17. 17.
    Kubo S, Goel VK, Yang SJ, Tajima N (2002) The biomechanical effects of multilevel posterior foraminotomy and foraminotomy with double-door laminoplasty. J Spinal Disord Tech 15:477–485CrossRefPubMedGoogle Scholar
  18. 18.
    Liu WJ, Hu L, Chou PH, Wang JW, Kan WS (2016) Comparison of anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of cervical radiculopathy: a systematic review. Orthop Surg 8:425–431CrossRefPubMedGoogle Scholar
  19. 19.
    Mansfield HE, Canar WJ, Gerard CS, O’Toole JE (2014) Single-level anterior cervical discectomy and fusion versus minimally invasive posterior cervical foraminotomy for patients with cervical radiculopathy: a cost analysis. Neurosurg Focus 37:E9CrossRefPubMedGoogle Scholar
  20. 20.
    Persson LC, Carlsson CA, Carlsson JY (1997) Long-lasting cervical radicular pain managed with surgery, physiotherapy, or a cervical collar. A prospective, randomized study. Spine (Phila Pa 1976) 22:751–758CrossRefGoogle Scholar
  21. 21.
    Samartzis D, Shen FH, Lyon C, Phillips M, Goldberg EJ, An HS (2004) Does rigid instrumentation increase the fusion rate in one-level anterior cervical discectomy and fusion? Spine J 4:636–643CrossRefPubMedGoogle Scholar
  22. 22.
    Scoville WB, Whitcomb BB (1966) Lateral rupture of cervical intervertebral disks. Postgrad Med 39:174–180CrossRefPubMedGoogle Scholar
  23. 23.
    Selvanathan SK, Beagrie C, Thomson S, Corns R, Deniz K, Derham C, Towns G, Timothy J, Pal D (2015) Anterior cervical discectomy and fusion versus posterior cervical foraminotomy in the treatment of brachialgia: the Leeds spinal unit experience (2008-2013). Acta Neurochir 157:1595–1600CrossRefPubMedGoogle Scholar
  24. 24.
    Shelerud RA, Paynter KS (2002) Rarer causes of radiculopathy: spinal tumors, infections, and other unusual causes. Phys Med Rehabil Clin N Am 13:645–696CrossRefPubMedGoogle Scholar
  25. 25.
    Tschugg A, Neururer S, Scheufler KM, Ulmer H, Thome C, Hegewald AA (2014) Comparison of posterior foraminotomy and anterior foraminotomy with fusion for treating spondylotic foraminal stenosis of the cervical spine: study protocol for a randomized controlled trial (ForaC). Trials 15:437CrossRefPubMedPubMedCentralGoogle Scholar
  26. 26.
    Voo LM, Kumaresan S, Yoganandan N, Pintar FA, Cusick JF (1997) Finite element analysis of cervical facetectomy. Spine 22:964–969CrossRefPubMedGoogle Scholar
  27. 27.
    Webb KM, Kaptain G, Sheehan J, Jane JA Sr (2002) Pediculotomy as an adjunct to posterior cervical hemilaminectomy, foraminotomy, and discectomy. Neurosurg Focus 12:E10CrossRefPubMedGoogle Scholar
  28. 28.
    Wolff MW, Levine LA (2002) Cervical radiculopathies: conservative approaches to management. Phys Med Rehabil Clin N Am 13:589–608. vii CrossRefPubMedGoogle Scholar
  29. 29.
    Wu TK, Wang BY, Meng Y, Ding C, Yang Y, Lou JG, Liu H (2017) Multilevel cervical disc replacement versus multilevel anterior discectomy and fusion: a meta-analysis. Medicine 96:e6503CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    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 74:22–27CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Austria 2017

Authors and Affiliations

  • Dong Geun Lee
    • 1
  • Choon Keun Park
    • 1
  • Dong Chan Lee
    • 2
  1. 1.Department of Neurosurgery, Spine CenterThe Leon Wiltse Memorial HospitalSuwonSouth Korea
  2. 2.Department of Neurosurgery, Spine CenterThe Leon Wiltse Memorial HospitalAnyangSouth Korea

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