gms | German Medical Science

57th Annual Meeting of the German Society of Neurosurgery
Joint Meeting with the Japanese Neurosurgical Society

German Society of Neurosurgery (DGNC)

11 - 14 May, Essen

Cervical foraminotomy: A comparison between the subperiosteal and the transmuscular approach

Die zervikale Foraminotomie: Ein Vergleich zwischen dem subperiostalen und transmuskulärem Zugang

Meeting Abstract

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  • corresponding author E. Fritzsche - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf
  • L. Papavero - Neurochirurgische Klinik, Universitätsklinikum Hamburg-Eppendorf

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 57. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie e.V. (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie. Essen, 11.-14.05.2006. Düsseldorf, Köln: German Medical Science; 2006. DocFR.02.01

The electronic version of this article is the complete one and can be found online at:

Published: May 8, 2006

© 2006 Fritzsche et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.



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.