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Posterior Cervical Microscopic Foraminotomy and Discectomy with Laser for Unilateral Radiculopathy.

Jeon HC, Kim CS, Kim SC, Kim TH, Jang JW, Choi KY, Moon BJ, Lee JK - Chonnam Med J (2015)

Bottom Line: Preoperative radicular symptoms were improved immediately after surgery in all patients.Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases.Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Buk-gu Wooridul Spine Hospital, Gwangju, Korea.

ABSTRACT
Surgical decompression for cervical radiculopathy includes anterior cervical discectomy and fusion, anterior or posterior cervical foraminotomy, and cervical arthroplasty after decompression. The aim of this study was to evaluate the usefulness of a CO2 laser in posterior-approach surgery for unilateral cervical radiculopathy. From January 2006 to December 2008, 12 consecutive patients with unilateral cervical radiculopathy from either foraminal stenosis or disc herniation, which was confirmed with imaging studies, underwent posterior foraminotomy and discectomy with the use of a microscope and CO2 laser. For annulotomy and discectomy, we used about 300 joules of CO2 laser energy. Magnetic resonance imaging (MRI) was used to evaluate the extent of disc removal or foraminal decompression. Clinical outcome was evaluated by using visual analogue scale scores for radicular pain and Odom's criteria. For evaluation of spinal stability, cervical flexion and extension radiographs were obtained. Single-level foraminotomy was performed in 10 patients and two-level foraminotomies were performed in 2 patients. Preoperative radicular symptoms were improved immediately after surgery in all patients. No surgery-related complications developed in our cases. Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases. There was no development of cervical instability during the follow-up period. Posterior foraminotomy and discectomy using a microscope and CO2 laser is an effective surgical tool for unilateral cervical radiculopathy caused by lateral or foraminal disc herniations or spondylotic stenosis. Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability.

No MeSH data available.


Related in: MedlinePlus

The clinical outcome according to the Odom's criteria. X: time on F/U, Y: number of patient.
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Figure 1: The clinical outcome according to the Odom's criteria. X: time on F/U, Y: number of patient.

Mentions: Postoperative VAS scores for radicular symptoms improved or resolved in all patients compared with preoperative states (Table 1). For Odom's criteria, excellent (33.3%) or good (50%) results were obtained at discharge, and patients returned to their preoperative employment and physical activity. At the last follow-up, 11 patients (91.7%) showed excellent or good clinical outcomes with respect to Odom's criteria, and 1 patient (8.3%) was fair at the last follow-up (Fig. 1). His follow-up MRI at 40 months after surgery showed recurrence of disc herniation. Although we recommended ACDF, he refused it and wanted conservative treatment. The postoperative MRI confirmed extensive decompression of the disc protrusion and widening of the cervical foraminal space. In serial follow-up with plain radiographs, the development of significant cervical kyphosis was not detected at the last follow-up. The mean preoperative segmental angulation was 12.4 degrees, and the mean postoperative segmental angulation was 12.0 degrees in our series. At the last follow-up, it was 17.6 degrees. Although two patients had complained of axial neck pain postoperatively, this resolved within 3 months. Furthermore, there were no surgery-related complications.


Posterior Cervical Microscopic Foraminotomy and Discectomy with Laser for Unilateral Radiculopathy.

Jeon HC, Kim CS, Kim SC, Kim TH, Jang JW, Choi KY, Moon BJ, Lee JK - Chonnam Med J (2015)

The clinical outcome according to the Odom's criteria. X: time on F/U, Y: number of patient.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4697113&req=5

Figure 1: The clinical outcome according to the Odom's criteria. X: time on F/U, Y: number of patient.
Mentions: Postoperative VAS scores for radicular symptoms improved or resolved in all patients compared with preoperative states (Table 1). For Odom's criteria, excellent (33.3%) or good (50%) results were obtained at discharge, and patients returned to their preoperative employment and physical activity. At the last follow-up, 11 patients (91.7%) showed excellent or good clinical outcomes with respect to Odom's criteria, and 1 patient (8.3%) was fair at the last follow-up (Fig. 1). His follow-up MRI at 40 months after surgery showed recurrence of disc herniation. Although we recommended ACDF, he refused it and wanted conservative treatment. The postoperative MRI confirmed extensive decompression of the disc protrusion and widening of the cervical foraminal space. In serial follow-up with plain radiographs, the development of significant cervical kyphosis was not detected at the last follow-up. The mean preoperative segmental angulation was 12.4 degrees, and the mean postoperative segmental angulation was 12.0 degrees in our series. At the last follow-up, it was 17.6 degrees. Although two patients had complained of axial neck pain postoperatively, this resolved within 3 months. Furthermore, there were no surgery-related complications.

Bottom Line: Preoperative radicular symptoms were improved immediately after surgery in all patients.Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases.Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Buk-gu Wooridul Spine Hospital, Gwangju, Korea.

ABSTRACT
Surgical decompression for cervical radiculopathy includes anterior cervical discectomy and fusion, anterior or posterior cervical foraminotomy, and cervical arthroplasty after decompression. The aim of this study was to evaluate the usefulness of a CO2 laser in posterior-approach surgery for unilateral cervical radiculopathy. From January 2006 to December 2008, 12 consecutive patients with unilateral cervical radiculopathy from either foraminal stenosis or disc herniation, which was confirmed with imaging studies, underwent posterior foraminotomy and discectomy with the use of a microscope and CO2 laser. For annulotomy and discectomy, we used about 300 joules of CO2 laser energy. Magnetic resonance imaging (MRI) was used to evaluate the extent of disc removal or foraminal decompression. Clinical outcome was evaluated by using visual analogue scale scores for radicular pain and Odom's criteria. For evaluation of spinal stability, cervical flexion and extension radiographs were obtained. Single-level foraminotomy was performed in 10 patients and two-level foraminotomies were performed in 2 patients. Preoperative radicular symptoms were improved immediately after surgery in all patients. No surgery-related complications developed in our cases. Postoperative MRI demonstrated effective decompression of ventral lesions and widened foraminal spaces in all cases. There was no development of cervical instability during the follow-up period. Posterior foraminotomy and discectomy using a microscope and CO2 laser is an effective surgical tool for unilateral cervical radiculopathy caused by lateral or foraminal disc herniations or spondylotic stenosis. Long-term follow-up with radiographs showed no significant kyphotic changes or spinal instability.

No MeSH data available.


Related in: MedlinePlus