Complications, outcomes, and need for fusion after minimally invasive posterior cervical foraminotomy and microdiscectomy

• Published in: The spine journal 2014-10, Vol.14 (10), p.2405-2411
• Main Authors: Skovrlj, Branko, MD, Gologorsky, Yakov, MD, Haque, Raqeeb, MD, Fessler, Richard G., MD, PhD, Qureshi, Sheeraz A., MD
• Format: Article
• Language: English
• Subjects: Adjacent-level disease; Adult; Anterior cervical fusion; Cervical Vertebrae - surgery; Cohort Studies; Complications; Disability Evaluation; Diskectomy - adverse effects; Diskectomy - methods; Female; Follow-Up Studies; Foraminotomy - adverse effects; Foraminotomy - methods; Humans; Incidence; Male; Microdiscectomy; Middle Aged; Minimally Invasive Surgical Procedures - adverse effects; Minimally Invasive Surgical Procedures - methods; Orthopedics; Outcome scores; Pain Measurement; Posterior cervical foraminotomy; Postoperative Complications; Prospective Studies; Radiculopathy - surgery; Reoperation; Retrospective Studies; Spinal Fusion - statistics & numerical data; Treatment Outcome
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2014.01.048

Abstract Background context Posterior cervical foraminotomy (PCF) with or without microdiscectomy (posterior cervical discectomy [PCD]) is a frequently used surgical technique for cervical radiculopathy secondary to foraminal stenosis or a laterally located herniated disc. Currently, these procedures are being performed with increasing frequency using advanced minimally invasive techniques. Although the safety and efficacy of minimally invasive PCF/PCD (MI-PCF/PCD) have been established, reports on long-term outcome and need for secondary surgical intervention at the index or adjacent level are lacking. Purpose To determine the rates of complications, long-term outcomes, and need for secondary surgical intervention at the index or adjacent level after MI-PCF and microdiscectomy. Study design Retrospective analysis of a prospective cohort. Patient sample Seventy patients treated with MI-PCF and/or MI-PCD for cervical radiculopathy. Outcome measures Visual Analog Scale for neck/arm (VASN/A ) pain and Neck Disability Index (NDI). Methods Ninety-seven patients underwent MI-PCF with or without MI-PCD between 2002 and 2011. Adequate prospective follow-up was available for 70 patients (95 cervical levels). The primary outcome assessed was need for secondary surgical intervention at the index or adjacent level. The secondary outcomes assessed included complications and improvements in NDI and VASN/A scores. All complications were reviewed. Mixed-model analyses of variance with random subject effects and autoregressive first-order correlation structures were used to test for differences among NDI, VASA , and VASN measurements made over time while accounting for the correlation among repeated observations within a patient. All statistical hypothesis tests were conducted at the 5% level of significance. Results Patients were followed for a mean of 32.1 months. Of 70 patients operated, there were 3 (4.3%) complications (1 cerebrospinal fluid leak, 1 postoperative wound hematoma, and 1 radiculitis), none of which required a secondary operative intervention. Five patients required an anterior cervical discectomy and fusion (eight total levels fused) on average 44.4 months after the index surgery. Of those, five (5.3%) were at the index level and three (2.1%) were at adjacent levels. Neck Disability Index scores improved significantly (p