gms | German Medical Science

63rd Annual Meeting of the German Society of Neurosurgery (DGNC)
Joint Meeting with the Japanese Neurosurgical Society (JNS)

German Society of Neurosurgery (DGNC)

13 - 16 June 2012, Leipzig

Ten-year follow-up after posterior foraminotomy of lateral disc herniations

Meeting Abstract

  • K.D. Martin - Klinik und Poliklinik für Neurochirurgie des Universitätsklinikums Carl-Gustav-Carus der Technischen Universität Dresden
  • V. Eichhorn - Klinik und Poliklinik für Neurochirurgie des Universitätsklinikums Carl-Gustav-Carus der Technischen Universität Dresden
  • M. Kirsch - Klinik und Poliklinik für Neurochirurgie des Universitätsklinikums Carl-Gustav-Carus der Technischen Universität Dresden
  • G. Schackert - Klinik und Poliklinik für Neurochirurgie des Universitätsklinikums Carl-Gustav-Carus der Technischen Universität Dresden
  • S.B. Sobottka - Klinik und Poliklinik für Neurochirurgie des Universitätsklinikums Carl-Gustav-Carus der Technischen Universität Dresden

Deutsche Gesellschaft für Neurochirurgie. Japanische Gesellschaft für Neurochirurgie. 63. Jahrestagung der Deutschen Gesellschaft für Neurochirurgie (DGNC), Joint Meeting mit der Japanischen Gesellschaft für Neurochirurgie (JNS). Leipzig, 13.-16.06.2012. Düsseldorf: German Medical Science GMS Publishing House; 2012. DocDO.13.09

DOI: 10.3205/12dgnc122, URN: urn:nbn:de:0183-12dgnc1220

Published: June 4, 2012

© 2012 Martin et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by-nc-nd/3.0/deed.en). You are free: to Share – to copy, distribute and transmit the work, provided the original author and source are credited.


Outline

Text

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.

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 operations due to recurrence of herniated disc and 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.

Conclusions: 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.