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

作者：Kim Chi Heon; Kim Kyoung Tae; Chung Chun Kee; Park Sung Bae; Yang Seung Heon; Kim Sung Mi; Sung Joo Kyung

来源：European Spine Journal, 2015, 24(12): 3005-3012.

DOI：10.1007/s00586-015-4198-1

• Cervical vertebrae
• Disk
• Percutaneous
• Tubular retractor
• Endoscopes

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 1.45A degrees (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 1.45A degrees) seemed to be associated with poor outcome and this may be considered in selecting surgical methods.

• 出版日期2015-12