gms | German Medical Science

Objective: Posterior foraminotomy is an alternative to anterior cervical discectomy (ACD) in patients with a lateral cervical disc herniation. This approach preserves mobility of the treated spinal segment.

Patients and Methods: 69 patients (M=45/F=24) with cervical monoradiculopathy were treated by posterior foraminotomy with a mean follow up period of ten years. The hospital charts, magnetic resonance imaging studies, and follow-up records of all patients were reviewed. The presenting symptoms were: radicular pain (58 patients), paraesthesia (44), neck pain (51), dermatomal sensory loss (64) and motor deficit (34 patients). All operations were performed at a single level (C4/C5 in 4 cases, C5/C6 in 17 cases, C6/C7 in 38 cases, C7/Th1 in 10 cases). Outcome was assessed by neurological status, visual analog scale (VAS) for neck and arm pain, and socio-economic aspects.

Results: Herniated disc material was removed in 56 cases; dorsal nerve root decompression alone was performed in 13 patients. Significant relief of radicular pain was achieved in 96% early after surgery. Transient improvement with unsatisfactory late outcome was observed in 3 patient. Satisfactory late outcome (according to Neck-Pain-Disability-Index) was obtained in 83% of patients. Complete or marked improvement of radicular pain was observed in 74%, neck pain in 53%, sensory loss in 55% and motor deficit in 77%. Long-term complications included eight reoperation (ACD) including four secondary operation due to recurrence of herniated discand 16 patients with longstanding neck pain. No evidence for an adjacent-level syndrome was found in any patient. There was no case of spinal instability.

Discussion: Posterior cervical foraminotomy is safe and effective in the management of lateral cervical disc herniation manifested by radiculopathy. Coexistence of osteophytes does not limit the use of this technique. The risk of herniation recurrence and spinal instability is very low. The minimal invasiveness of this method allows fast return to normal life activities and a good long-term outcome can be expected.