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Posterior foraminotomy for cervical Posterior foraminotomy for cervical radiculopathy; A comparison among direct radiculopathy; A comparison among direct (naked eye), microscopic and endoscopic (naked eye), microscopic and endoscopic

visualizationvisualization

Akiyoshi YamazakiAkiyoshi Yamazaki, Keiichi Katsumi, Masayuki , Keiichi Katsumi, Masayuki Ohashi, Hirokazu Shoji, Yasuaki SuharaOhashi, Hirokazu Shoji, Yasuaki Suhara

Spine Center, Dept. of Orthop. Surg., Spine Center, Dept. of Orthop. Surg., Niigata Central Hospital, Niigata, JapanNiigata Central Hospital, Niigata, Japan

EuroSpine 2011, EuroSpine 2011, OctOct. . 1919-21-21, Milan, Milan, , Italy Italy

• Cervical posterior foraminotomy is one of the Cervical posterior foraminotomy is one of the standard methods that can be performed under standard methods that can be performed under direct (naked eye), microscopic, or endoscopic direct (naked eye), microscopic, or endoscopic visualization.visualization.

• The purpose of this study is to compare the The purpose of this study is to compare the usefulness of posterior foraminotomy performed usefulness of posterior foraminotomy performed under these 3 waysunder these 3 ways..

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PurposePurpose

3

patientspatients

1818

68688888

1717

•Osteophytes anterior to the nerve root were not removed.Osteophytes anterior to the nerve root were not removed.•Disc hernia was removed as much as possible.Disc hernia was removed as much as possible.

1 level1 level: : 1201202 levels2 levels:: 27 273 levels:3 levels: 1 14 levels4 levels:: 2 2Bilat. (1 level):Bilat. (1 level): 33

LevelsLevels

Materials and MethodsMaterials and Methods

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NakedNaked MicroMicro Endo Endo (METRx)(METRx)

differencedifference

TimeTime Sept. ’00 – Nov. ’02Sept. ’00 – Nov. ’02 Nov. ’02 - Nov. ’02 - Dec. ’05 -Dec. ’05 -

Patients / DiscsPatients / Discs 19 / 21 19 / 21 (1- 2)(1- 2) 104 / 133 104 / 133 (1- 4)(1- 4) 30 / 37 30 / 37 (1- 2)(1- 2)

Skin incisionSkin incision 5 cm / level5 cm / level 5 cm / level5 cm / level 2 cm2 cm

StenosisStenosis ：：HerniaHernia

1: 0.81: 0.8 1: 0.71: 0.7 1: 0.31: 0.3 N.S.N.S.

AgeAge （（ yy ）） 4949 5151 5050 N.S.N.S.

BLBL （（ cmcm ）） 165165 166166 166166 N.S.N.S.

BWBW （（ kgkg ）） 6565 6565 6767 N.S.N.S.

Postop. FUPostop. FU（（ mm ））

2828 1515 1313 N.S.N.S.

** p<0.05 (ANOVA)

min

**

89

76

92

ResultsResults

Op. time (/ level)Op. time (/ level)

5

** p<0.05 (ANOVA)

cc **

144

6575

**

Blood loss (/level)Blood loss (/level)

6

7

NakedNaked MicroMicro EndoEndo

Motor weaknessMotor weakness (transient)(transient) 2 (C5, 7)2 (C5, 7) 1 (C7)1 (C7)

Dural tearDural tear (pin hole)(pin hole) 11 44 11

ComplicationsComplications

Not significantly different among 3 groups Not significantly different among 3 groups

Neurological recoveryNeurological recovery

• SensorySensory• MotorMotor

% of % of facet joint preservationfacet joint preservation

Ave.Ave.70% (43- 100)70% (43- 100)

** p<0.05 (Kruskal-Wallis)

mg/dl

**

1.0 0.9

0.3

**

CRP (P.O. 1w)CRP (P.O. 1w)

8

** p<0.05 (ANOVA)

times **

2.52.3

1.1

**

Time of analgesic usage (within P.O.1w)Time of analgesic usage (within P.O.1w)

9

** p<0.01, **** p<0.05 (ANOVA)

days ****

23

15

11

****

Hospital stay after surgeryHospital stay after surgery

10

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DiscussionDiscussion

NakedNaked MicroMicro EndoEndo

AdvantageAdvantage EasyEasy MicroscopicMicroscopic MicroscopicMicroscopic

Small incisionSmall incision

Less invasiveLess invasive

DisadvantageDisadvantage MacroscopicMacroscopic

More bleedingMore bleeding

2-D image2-D image

Small working spaceSmall working space

Long op. timeLong op. time

• Neurological recovery and % of facet joint preservation Neurological recovery and % of facet joint preservation were not significantly different among 3 groups. were not significantly different among 3 groups.

• With naked eyes, blood loss was significantly more due to With naked eyes, blood loss was significantly more due to macroscopic visualization. macroscopic visualization.

• Postoperative CRP, time of analgesic usage and hospital Postoperative CRP, time of analgesic usage and hospital stay were significantly less with endoscope.stay were significantly less with endoscope.

• Therefore endoscopic foraminotomy is as safe and Therefore endoscopic foraminotomy is as safe and effective as microscopic foraminotomy and even less effective as microscopic foraminotomy and even less invasive. invasive.

• Endoscopic foraminotomy would be preferable alternative Endoscopic foraminotomy would be preferable alternative to microscopic foraminotomy.to microscopic foraminotomy.

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ConclusionsConclusions

None of the authors has any potential conflict or interest.