gms | German Medical Science

Objective: The cervical spine offers different surgical therapy options to treat radicular pain syndromes. Most clinics prefer the anterior discectomy and cervical fusion as the treatment of choice. There are some groups providing the posterior approach for foraminotomy. The classical Fryckholm approach detaches the muscles from the spine process and causes postoperative neck pain. We provided the tubular assisted posterior approach to avoid this neck pain.

Method: In the last three years we used the tubular assisted microsurgical foraminotomy as a modified Fryckholm approach in 20 and the classical Fryckholm approach in 15 cervical radicular root syndromes in our institution. All patients were introduced to all treatment options. Inclusion criteria were soft or hard cervical disc herniation, degenerative spondylosis or bony foramen stenosis with corresponding radicular pain syndromes and without severe neurological deficits. All patients had an MRI and CT scan not older than three months prior to surgery and at least 6 weeks conservative treatment. Endpoints were neck pain, radicular pain, skin incision, operation time and hospitals stay. Pain was measured by the VAS preoperative, postoperative and every day until discharge

Results: The mean operation time was 69 min for the tubular assisted approach and 76 min for the classical Fryckholm approach and the mean hospital stay was 3 days in both. Radicular pain was relieved directly postoperative in all patients. The skin incision in the tubular assisted group was 2.2 cm and the neck pain decreased from 8 before surgery to 0–1 within the first two days after surgery compared to 3.2 cm skin incision and neck pain reduction from 8 to 2 at discharge in the classical Fryckholm approach. The differences were significant for the skin incision (p=0.02) and postoperative neck pain (p=0.001). No new deficit and no adverse surgery related complications were seen in both techniques. In all patients a postoperative CT scan was performed to document the extent of decompression. During the follow-up no instability was observed 6 and 12 weeks after surgery

Conclusions: The tubular assisted modified Fryckholm approach shows no disadvantages compared to the results of the classical Fryckholm approach. The advantages are in a shorter skin incision und the decrease of postoperative neck pain. The learning curve is very short and the expected operation time for this procedure is 45 to 60 minutes. Through a transmuscular approach less scar tissue and muscle atrophy is expected.