Posterior cervical foraminotomy for cervical radiculopathy: should cervical alignment be considered?

Concerning of progression of deformity, it is reluctant to utilize a posterior approach if preoperative sagittal alignment is kyphotic or straight. The purpose of this study was to determine interval changes in cervical segmental angles after posterior cervical foraminotomy (PCF) and analyzing factors affecting cervical sagittal re-alignment in the postoperative period.

Within 2 days and 6 months after PCF, postoperative plain radiograph was obtained to compare the cervical sagittal alignment with preoperative alignment in 286 consecutive patients. Sagittal angle between C2 and C7 formed by lines drawn at the base of axis and the superior endplate of the C7 vertebral body on lateral radiograph. To evaluate clinical outcomes, patients were routinely asked to gauge levels of pain they feeling at that point in time by visual analogue scale (VAS) on admission, prior to postoperative radiographs and 6 months after operation follow-up in outpatient.

More than two-third of the patients presenting with kyphotic or straight curvature improved short-term following operation. On follow-up plain radiographs after 6 months, the improvement of sagittal alignment was well maintained, but rather more prominent (P<0.05). Improvement in sagittal alignment was dominant when radiculopathy was due to softened discs, rather than stenosis (P<0.05, β=3.279), and with shorter symptom duration (P<0.05, β=-0.042). Age had no significant impact on outcomes (P=0.614) and count of affected levels also did not (P=0.366). In patients with higher preoperative VAS score, Cobb's angle was significantly lower (P<0.05, β=-0.460), and as perioperative VAS score declined, sagittal alignment improved significantly (P<0.05, β=-0.508).

Particularly in acute onset radiculopathies from softened discs, PCF is a valid surgical option, despite preoperative loss of normal lordotic sagittal alignment.