Introduction: Cervical microendoscopic foramintomy/discectomy (MEF/D) is an alternate minimally invasive technique developed for laterally located, soft disc herniations or foraminal stenosis. In this study, we attempted to determine patient outcomes, complications, and the necessity of a subsequent fusion.
Methods: Between 2002 and 2011, 70 patients were prospectively followed that underwent cervical MEF/D (96 levels) by two surgeons at two different institutions. Primary and secondary outcomes were evaluated, including 1) the need for fusion at index and adjacent levels and 2) improvement in NDI and VAS (both neck and arm). Mixed model analysis of variance statistical tests were used (with random subject effect and autoregressive order 1 correlation structures) to test for differences among VAS(A), VAS (N), and NDI. Complications of these surgeries were also analyzed.
Results: The mean range of follow-up was 26.2 months. Out of 95 total levels operated on, only five patients required and ACDF (avg. of 44.4 months following first surgery). Of those, 5 (5.3%) were at the index level and 3 (2.1%) were at adjacent levels. A low rate (1.1% per index level per year) of future index site fusion is reported, as well as very low rate (0.9% per adjacent level per year) of adjacent level disease requiring surgery. Three out of the 70 patients had complications (4.3%), none of which required a secondary surgery. VAS (neck and arm) improved significantly (p<0.0001) postoperatively, but was seen to plateau over time, whereas NDI scored improved significantly (p<0.0001) continuously over time.
Conclusions: MEF/D is an effective minimally invasive technique for properly selected patients, with a low rate of complications not requiring further surgeries. MEF/D has a low rate adjacent level disease necessitating fusion, and when compared to an ACDF, there is no difference in this rate between the two groups.
Patient Care: Help identify the issues involved with MIS cervical decompression
Learning Objectives: To identify the outcomes and complications related to cervical micronendoscopic decompression and neccessity for subsequent fusions