Does narrow foraminal height adversely affect outcomes of posterior cervical foraminotomy for cervical radiculopathy?

Posterior cervical foraminotomy (PCF) is an established motion-preserving alternative to anterior cervical discectomy and fusion (ACDF) for cervical radiculopathy. However, concerns remain regarding the efficacy of PCF in patients with vertically narrow foramina, where decompression in the craniocaudal direction is limited. This study was conducted to evaluate the impact of narrow foraminal height (FH; < 6 mm) on clinical and radiographic outcomes following PCF.

This retrospective cohort study reviewed the records of 82 patients who underwent PCF with ≥ 2 years of follow-up. Patients were categorized into narrow FH (n = 30) and high FH (n = 52) groups. Clinical outcomes included visual analog scale (VAS) scores for neck and arm pain, the Neck Disability Index (NDI), and the achievement of the minimal clinically important difference (MCID). Radiographic parameters and revision surgery rates were also assessed.

The narrow FH group had a significantly higher rate of revision surgeries (13.3% vs 0%, p = 0.016). Although both groups experienced significant pain reduction, only the high FH group showed significant improvement in NDI scores at 3 months. The proportion of patients achieving MCID for arm pain was significantly lower in the narrow FH group (p = 0.021). Postoperative cervical range of motion was also more restricted in the narrow FH group. FH did not significantly change postoperatively in either group.

Narrow FH adversely affects clinical outcomes and increases the risk of revision surgery following PCF. Surgeons should consider alternative approaches, such as ACDF, for patients with preoperative FH < 6 mm.