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  • Clinical Outcomes of Microendoscopic Foraminotomy and Decompression in the Cervical Spine

    Final Number:

    Zachary Adam Smith MD; Cort D. Lawton B.A; Richard G. Fessler MD

    Study Design:

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Cervical microendoscopic foraminotomy (CMEF) and cervical microendoscopic discectomy (CMED) are two minimally invasive procedures used in modern spinal practice to treat degenerative disease of the cervical spine. The use of these techniques may help to limit direct approach related morbidity and improve long-term outcomes.

    Methods: A total of 38 patients were included in the study, with a mean follow-up of 24.47 ±12.84 months. No patient was lost to long-term follow-up following study inclusion. Patients were followed prospectively with questionnaires consisting of a visual analog scale for the neck (VASN) and arm (VASA), and a neck disability index (NDI) form. Operative time, estimated blood loss, and hospitalization stay were also collected. Data was analyzed using Microsoft office excel 2007.

    Results: The mean 1 year follow-up scores all showed statistically significant improvements: NDI (p = 0.0019), VASN (p = 0.0017), VASA (p = < .0001). Similar results were seen at 2 year follow-up: NDI (p = 0.0011), VASN (p = 0.0022), VASA (p = < .0001); and at 3-6 year follow-up: NDI (p = 0.0015), VASN (p = 0.0200), VASA (p = 0.0034). The average operation time, hospitalization stay, and estimated blood loss were 154.27 ±26.79 minutes, 21.22 ±14.23 hours, 27.92 cc respectively. There were no statistically significant differences when patients were compared by age (over 50 vs. under 50), operative level (above C6 vs. below C6), or sex. No complications were reported in this study. No patients required re-operation or experienced instability as a result of the procedure.

    Conclusions: Posterior CMEF and CMED are safe and effective procedures for minimally invasive decompression in the cervical spine. Their continued implementation provide an important alternative to more traditional techniques.

    Patient Care: This research will allow us to understand how effective this minimally invasive approach is for patients who present primarily with cervical radiculopathy and little neck pain.

    Learning Objectives: 1. To understand the efficacy of posterior approaches for laminoforamintomy in the cervical spine. 2. To evaluate non-fusion options for cervical degenerative disease with radiculopathy.

    References: Cloward RB. The anterior approach for removal of ruptured cervical disks. Journal of neurosurgery. Nov 1958;15(6):602-617. 2. Clements DH, O'Leary PF. Anterior cervical discectomy and fusion. Spine. Oct 1990;15(10):1023-1025. 3. Henderson CM, Hennessy RG, Shuey HM, Jr., Shackelford EG. Posterior-lateral foraminotomy as an exclusive operative technique for cervical radiculopathy: a review of 846 consecutively operated cases. Neurosurgery. Nov 1983;13(5):504-512. 4. Hunter LY, Braunstein EM, Bailey RW. Radiographic changes following anterior cervical fusion. Spine. Sep-Oct 1980;5(5):399-401. 5. Olsewski JM, Garvey TA, Schendel MJ. Biomechanical analysis of facet and graft loading in a Smith-Robinson type cervical spine model. Spine. Nov 15 1994;19(22):2540-2544. 6. Hilibrand AS, Robbins M. Adjacent segment degeneration and adjacent segment disease: the consequences of spinal fusion? The spine journal : official journal of the North American Spine Society. Nov-Dec 2004;4(6 Suppl):190S-194S. 7. Ishihara H, Kanamori M, Kawaguchi Y, Nakamura H, Kimura T. Adjacent segment disease after anterior cervical interbody fusion. The spine journal : official journal of the North American Spine Society. Nov-Dec 2004;4(6):624-628.

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