Endoscopic anterior cervical foraminotomy for unilateral radiculopathy: anatomical morphometric analysis and...

Cervical radiculopathy is typically caused by posterolateral disc herniation or spondylotic foraminal stenosis, either of which may compress the ventral aspect of the nerve root. The authors undertook a study to establish the feasibility of performing an endoscopic approach for anterior cervical foraminotomy (ACFor) in a clinical setting.

Application of this method on cadavers was conducted to verify the practicability of this technique. The clinical study included 16 patients (eight men and eight women; mean age 46.6 years) all presenting with unilateral radicular symptoms (one at two adjacent ipsilateral levels), which were associated with various degrees of neck pain. Disc herniations and/or uncovertebral osteophytes were confirmed on magnetic resonance imaging and high-resolution computerized tomography scanning. A total of 17 endoscopic ACFors (one two-level procedure) were performed using a rigid glass endoscope (25 degrees angled, 3-mm diameter, 10-mm length) mounted on a tubular retractor. No major surgery-related complications were encountered. During a mean follow-up period of 13.8 months an average absolute improvement of 44% (p > 0.05) in the neck disability index score and of 96% (p > 0.05) in the visual analog scale score for radicular pain (compared with the preoperative score) was observed. During the follow-up period strength improved to normal in 84% and sensory deficit in 80% of the patients. The overall subjective patient satisfaction rate was 87.6%; the return-to-work rate after 4 weeks was 81.4%.

The advantages of endoscopic ACFor include minimial surgical exposure, improved intraoperative visualization, direct decompression of the nerve root, and the preservation of the intervertebral disc and the motion segment.