Effective cervical decompression by the posterior cervical foraminotomy without discectomy

A retrospective review.

To compare the effectiveness of the posterior cervical foraminotomy (PCF) with and without discectomy for the treatment of cervical disk herniation.

Although PCF is effective and does not require a fusion procedure, it has certain disadvantages, including a narrow operating field, the need for cervical nerve root retraction, and the obstacle of epidural venous bleeding. Surgeons often find that these limitations complicate the removal of the disk material during PCF.

The study evaluated 135 consecutive patients who underwent PCF for cervical disk herniation and were followed up for a mean of 36.1 months. Of these patients, 117 were treated with posterior foraminotomy with discectomy (group A); the remaining 18 patients were treated with PCF alone because the disk could not be removed (group B). The clinical data, neurological status, radiologic findings, location of pathology, clinical outcomes, and postoperative satisfaction were compared between the 2 groups.

The 2 groups had similar clinical outcomes. The mean visual analogue scale (VAS) score for radicular arm and neck pain improved from 7.8 and 5.7 to 4.6 and 3.6 in group A and from 6.6 and 6.2 to 3.4 and 3.6 in group B, and the mean Oswestry disability index (ODI) score from 39.6 and 38.7 to 23.2 and 17.6 in groups A and B, respectively. The success rates in groups A and B were 90.6% and 88.8%, respectively. Radiologic examination found significant differences in operative-level disk softness and disk type between the groups (P<0.05). Protruding, mixed-type, and C4-5 level were more difficult to remove and required more extensive foraminal unroofing.

Despite the surgical and anatomic limitations, PCF with or without discectomy is an effective treatment for cervical disk herniation.