Mini-open Posterior Cervical Foraminotomy With Tubular Retractors:A Clinical Trial

BACKGROUND CONTEXT: Cervical radiculopathy is one of the most common pathologies treated by spinal surgeons.Although many patients will respond to appropriate nonoperative measures, those who continue to be symptomatic have several surgical options available. anterior cervical discectomy and fusion(ACDF) remains the gold standard for the surgical treatment of cervical radiculopathy,because of its safety and effectiveness.Along with its many advantages, the anterior cervical approach also carries with it an increased risk of injury to the trachea, esophagus, carotid artery, and recurrent laryngeal nerve.Furthermore, anterior decompression generally necessitates fusion at that level, thereby resulting in unavoidable loss of mobility and increased risk of adjacent-level degenerative changes.The open posterior approach avoids many of the complications associated with anterior access and spinal fusion; however, this technique requires extensive subperiosteal dissection of the paraspinal musculature.During the last decade, minimally invasive approaches have been developed to achieve similar results to the more traditional procedures,with a reduction in intraoperative blood loss,tissue damage, length of hospitalization, postoperative pain,and infection rate.Minimally invasive posterior Cervical foraminotomy(MI-PCF/PCD) achieving similar nerve root decompression and bony resection compared with traditional open techniques.Now the technology has been widely used in the the treatment of cervical radiculopathy secondary to foraminal stenosis or a laterally located herniated disc.OBJECTIVE:Our aim was to evaluate the efficacy of Mini-open posterior Cervical foraminotomy with tubular retractors,a clinically follow-up was available for patients who was treated with this procedure and prospectively collect the relevant data.Through a retrospective analysis of all results.this article summarizes our clinical experience with MI-PCF/PCD.METHODS:Since 2011,a total of 12 patients were included in the study. The patients’ preoperative demographic,surgical,and postoperative outcome data were collected and recorded.Patients were routinely evaluated the disability and pain levels, using the Neck Disability Index(NDI) and Visual Analog Scale(VAS) instruments. Other data were also collected,including the operation time and estimated blood loss, time of hospitalization, as well as complications. Mixed-model analyses of variance with random subject effects and auto regressive 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 1% level of significance.RESULTS:The average operation time, hospitalization stay,and estimated blood loss were 67.5 minutes,34.2 m L and 3.2 days,respectively. The postoperative outcome yielded symptomatic improvement for 92% of patients:4 resolved(33.3%),7 improved(58.3%),1 unchanged(33.3%).Patients were followed for a mean of 16 months,ranged from 14 to 40 months. The mean 6 month follow-up scores all showed statistically significant improvements: NDI(P=0.0019),VASN(P=0.0017),VASA(P≤0.0001).Similar results were seen at 1 year follow-up:NDI(P=0.0011),VASN(P=0.0022)and VASA(P≤0.0001) and at 2 year follow-up: NDI(P=0.0015),VASN(P=0.0200),VASA(P=0.0034). One complication was reported in this study consisting of Incision hematoma, which required no further intervention.During the long-term follow up of the patients, there were one case appear the complications of cervical instability.CONCLUSION: Mini-open posterior cervical foraminotomy with tubular retractors are safe and effective procedures for treatment of cervical radiculopathy.