Long-Term Outcome of Posterior Cervical Inclinatory Foraminotomy

Abstract

Objective : A modified surgical technique of posterior cervical foramintomy called posterior cervical inclinatory foraminotomy ( PCIF) was introduced in previous preliminary article. PCIF allows better preservation of facet joint and capsule than conventional techniques. The authors conducted a study to investigate long-term outcomes of PCIF. Methods : We retrospectively reviewed demographic, radiologic, and clinical data from the patients who underwent PCIFs at our institution. Criteria included a minimum of 48 month follow-up and PCIFs for patients with radiculopathy from foraminal stenosis ( C2-T1; single or multilevel) with persistent or recurrent root symptoms despite conservative treatment for more than 3 months. Patients who had undergone previous cervical operation were excluded. The visual analogue scale ( VAS) score was used for clinical follow-up, and radiologic follow-up was performed to compare the changes of cervical sagittal alignment, focal angle and disc-space height of treated segment. Results : The PCIFs were performed between April 2007 and March 2011 on 46 patients ( 32 males and 14 females) with a total of 73 levels affected. The average duration of follow-up was 74.4 months. Improvements in radiculopathic pain were seen in 39 patients ( 84.7%), and VAS score decreased from 6.82+/- 1.9 to 2.19+/- 1.9. Posterior neck pain also improved in 25 patients ( 71.4%) among 35 patients, and VAS score decreased from 4.97+/- 2.0 to 2.71+/- 1.9. The mean disc-space heights of treated segment were 5.41+/- 1.03 mm preoperatively and decreased to 5.17+/- 1.12 mm postoperatively. No statistically significant changes in cervical sagittal alignment, focal angle were seen during the follow-up period ( Cox proportional hazards analysis and Student t-test, p>0.05). Conclusion : The PCIF is highly effective in treating patients with cervical spondylotic radiculopathy, leading to long-lasting relief in pain. Long-term radiologic follow-up showed no significant spinal angular imbalance.