gms | German Medical Science

Objective: Dorsal foraminotomy is an effective treatment for intraforaminal cervical disc herniations Usually, symptoms as radicular pain or neurological deficits decrease soon after surgery. However, most of the patients complain about long-lasting neckpain. The aim of this study was to investigate whether the transmuscular approach via a small tubular retractor reduces postsurgical neckpain.

Methods: Fifty-three patients with a lateral disc herniation underwent microsurgical foraminotomy. In 19 cases (Group A) a conventional subperiosteal approach using a Caspar speculum counter-retractor system was used. In 34 patients (Group B) a miniaturized procedure was performed. The microscope was used from the skin. Through a 2 cm incision 15 mm off the midline, the single muscle layers were bluntly split according to the direction of their muscle fibers. An expandable tubular retractor (15mm diameter) was inserted onto the laminofacet junction. All subsequent steps corresponded to the conventional microsurgical foraminotomy. A retrospective analysis was carried out by an independent observer. Neck- and arm pain were scored according to the visual analogue scale (VAS) preoperatively, 3 days and 6 months following surgery.

Results: There were 20 female and 33 male with a mean age of 49 yrs. Patients presented with sensory (95%), motor (74%) deficits and radicular pain (80%). The most frequently affected level was C6/7. Forty-six single-level and 7 two-level approaches were performed. Neck pain decreased in Group A from 5.6 to 2.1 and 2.3 after 6 months; in Group B from 5.1 to 1.5 and 0.7 after 6 months. Radicular pain decreased in Group A from 7.5 to 1.2 and 0.9 after 6 months; in Group B from 7.6 to 1.0 and 0.2 after 6 months. No complications were seen.

Conclusions: Both approaches compare well in terms of relief of the radicular symptoms. The transmuscular approach provides the advantage of less neck pain. This allows for an immediate neck mobilization.